If you don’t want an attorney to help you investigate or report the fraud and you refuse to accept a DOJ reward, then you can contact CMS directly to report Medicare fraud. You can even call a CMS hotline or fill out a form anonymously.

The biggest benefit of reporting fraud this way is that it is easy and quick. However, the downside is that you won’t know if the government ever opened an investigation. CMS has no duty to contact you or let you know the status or results of any investigation.

At the same time, not everyone is willing to become a named whistleblower or spend the amount of time it takes to put together a full description of the Medicare fraud needed to file for a DOJ reward.

 

Here’s how to report fraud directly to CMS:

  • Call CMS at 1-800-MEDICARE (1-800-633-4227).
  • Report it online to the Office of the Inspector General (https://oig.hhs.gov/fraud/report-fraud/index.asp).
  • Call the Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY: 1-800-377-4950.

 

According to the CMS website, CMS has the authority in some circumstances to give a very small reward to those reporting fraud directly to it, but the amount is limited to $1,000. There are other limits to receiving a CMS reward, which are described on the CMS website.

For more information about reporting fraud directly to CMS, see the CMS website at: https://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/reporting-fraud.html

If you do not want a reward, you can also consider contacting the State Attorney General (AG) and the local district attorney who are primarily responsible for enforcing State laws.  You can also contact the U.S. Attorney located in your State, which is responsible for investigating allegations of fraud against the federal government.  However, by contacting others, including government agencies, you might not be able to later claim a reward because there are many technical requirements that must be met. Bear in mind that the statute of limitations for filing for a reward may be as short as three years (but in some cases six years depending upon the type of fraud), and that your ability to file such a suit may be cut off earlier if someone else publicizes the conduct at issue, if someone else files before you, or if the government is otherwise spurred into action.

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