Medical fraud is a serious crime that affects millions of Americans each year. If you suspect that you or a loved one has been a victim of medical fraud, it is crucial to act immediately. Reporting medical fraud can help protect others from falling victim to the same scheme and can also help you recover any financial losses you may have incurred. The Ozempic injury lawyers at Shapiro Legal Group, PLLC have compiled this article to help you find your state’s resources for reporting suspected medical fraud.
Types of Medical Fraud
Medical fraud comes in many forms, but some of the most common types include:
- Medical Identity Theft: This occurs when someone uses your personal information, such as your name, Social Security number, or health insurance number, to obtain medical services or prescription drugs. The thief may also use your information to submit false claims to your insurance company.
- Upcoding: This happens when a healthcare provider bills for a more expensive service than the one provided. For example, a doctor may bill for a comprehensive exam when only a basic exam was performed.
- Billing for Unnecessary Services: Some healthcare providers may order unnecessary tests, procedures, or treatments in order to increase their billing revenue. This not only wastes money but also puts patients at risk of harm from unnecessary medical interventions.
- Billing for Unprovided Services: A healthcare provider bills for services that were never actually provided to the patient. This can include billing for appointments that never happened or for treatments that were never administered.
Dangerous and Defective Drugs
When a drug is found to be defective or dangerous, the manufacturer may be held liable for any injuries or illnesses caused by the drug. A drug may be defective in its design, which means it is inherently dangerous or ineffective due to its chemical composition or pharmacological properties. A drug may also be defective due to manufacturing errors, such as contamination, mislabeling, or improper production.
Some pharmaceutical companies engage in fraudulent marketing practices. This can include promoting drugs for unapproved uses, downplaying the risks of a drug, or failing to disclose known side effects.
Nationwide Resources for Reporting Medical Fraud
If you suspect medical fraud, there are several nationwide resources available to help you report it. The FBI has a dedicated Health Care Fraud unit that investigates and prosecutes cases of medical fraud. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) also investigates cases of medical fraud.
If you suspect fraud related to Medicare or Medicaid, you can report it to the Centers for Medicare & Medicaid Services (CMS). CMS has a dedicated fraud unit that investigates and prosecutes cases related to these government healthcare programs.
Resources for Reporting Medical Fraud by U.S. State
Each state has its own resources and procedures for reporting suspected medical fraud. Make sure to contact the appropriate agency in your state so that your report can be properly investigated.
Alabama
Report suspected Medicaid fraud or abuse to the Alabama Medicaid Agency’s Program Integrity Division. You can call their toll-free hotline at (866) 452-4930 or write a letter to PO Box 5624, Montgomery, AL 36103-5624.
Alaska
The Alaska Medicaid Fraud Control Unit investigates and prosecutes Medicaid fraud and patient abuse or exploitation. To report fraud, call their hotline at (907) 269-6279 or submit a complaint form.
Arizona
The Office of Inspector General (OIG) investigates reports of suspected fraud. Anyone can report fraud anonymously using their online form or by calling (602) 417-4045 or (888) 487-6686 (toll-free).
Arkansas
In Arkansas, you can report suspected Medicaid fraud to the state Department of Human Services. Submit your report by calling (800) 422-6641 or emailing ContactDHSFraud@arkansas.gov.
California
To report suspected Medi-Cal fraud, waste, or abuse in California, call the Department of Health Care Services (DHCS) Medi-Cal Fraud Hotline at (800) 822-6222 or submit a complaint online.
Colorado
If you suspect fraud in Colorado, call the Department of Human Services (CDHS) Fraud Hotline at (877) 934-6361 or fill out the online form on this page.
Connecticut
Report healthcare fraud by emailing the complaint form to ag.fraud@ct.gov, calling the Fraud Hotline at (860) 808-5354, or mailing the form to the Office of the Attorney General, Antitrust and Government Program Fraud Department, P.O. Box 120, Hartford, CT 06141-0120.
Delaware
In Delaware, report suspected Medicaid fraud, waste, abuse, or quality of care issues by completing this online form or calling (800) 372-2022.
Florida
Use the Florida Agency for Health Care Administration – Office of Inspector General’s online Medicaid Fraud and Abuse Complaint Form to report suspected fraud and or abuse in the Florida Medicaid system.
Georgia
To report suspected Medicaid fraud in Georgia, call (404) 656-4409 or email the details of your complaint to DPH-ReportFraud@dph.ga.gov. You can also make a formal complaint by contacting the Department of Public Health, Office of Inspector General.
Hawaii
If you suspect Medicaid fraud in Hawaii, contact one of the fraud hotlines for the QUEST health plans or call the Medicaid Investigator at (808) 692-8072.
Idaho
In Idaho, report healthcare fraud by Medicaid providers to the Medicaid Program Integrity Unit directly at 208-334-5754, by fax at 208-334-2026, by email at prvfraud@dhw.Idaho.gov, or by mail at PO Box 83720, Boise, ID 83720-0036.
Illinois
In Illinois, report Medicaid fraud online, by phone at (844) 453-7283, or in person at any Family Community Service Resource Center.
Indiana
The Indiana Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General investigates provider fraud. Submit a report online through their website.
Iowa
To report potential Medicaid fraud, waste, or abuse in Iowa, contact the Medicaid Program Integrity Unit toll-free at (877) 446-3787 or locally in Des Moines at 515-256-4615.
Kansas
Report suspected cases of Medicaid fraud or abuse to the Attorney General’s Medicaid Fraud and Abuse Division at (866) 551-6328 or (785) 368-6220, or use the online reporting form.
Kentucky
In Kentucky, the Office of Medicaid Fraud & Abuse investigates provider fraud. To file a report, call the Medicaid Fraud and Abuse Hotline at 1-877-ABUSE TIP (1-877-228-7384) or complete the online Medicaid Fraud and Abuse Complaint Form.
Louisiana
To alert the Louisiana Department of Health, call the toll-free Provider Fraud hotline at (800) 488-2917, complete the online form, or submit your complaint by mail to the Program Integrity Unit – Provider Complaints at the Louisiana Department of Health, Bienville Building, P.O. Box 91030, Baton Rouge, LA 70821.
Maine
In Maine, report Medicaid fraud and abuse to the Department of Health and Human Services by calling toll-free at (800) 442-6003, locally at (207) 287-2409, or via TDD at (207) 287-6948.
Maryland
To report fraud, waste, or abuse in Maryland, contact the Office of the Inspector General (OIG). Call the OIG Hotline at (866) 770-7175 or complete and submit the online form on this page.
Massachusetts
If you have a fraud complaint against a healthcare licensee in Massachusetts, report it to the Health Care Fraud Unit by calling (617) 973-0865.
Michigan
To report Medicaid fraud, call the Michigan Department of Health and Human Services toll-free at 855-MI-FRAUD (855-643-7283), complete the online complaint form here, or write to the Office of Inspector General, P.O. Box 30062, Lansing, MI 48909.
Minnesota
To file a health insurance fraud report in Minnesota, call the MNsure anonymous complaints telephone line at (844) 466-7873 or send a message to mnsurecompliancehotline@mnsure.org.
Mississippi
In Mississippi, report fraud or abuse by calling the toll-free number (800) 880-5920 or the local number (601) 576-4162. You can also send a letter to the Office of Program Integrity at 550 High Street, Suite 1000, Jackson, MS 39201, or complete the online form here.
Missouri
Report fraud to the Missouri Medicaid Audit and Compliance (MMAC) Fraud Hotline at (573) 751-3285 or email MMAC.ReportFraud@dss.mo.gov.
Montana
To report suspected Medicaid fraud in Montana, contact the Department of Public Health and Human Services (DPHHS) Hotline at (800) 201-6308.
Nebraska
The Nebraska Medicaid Fraud and Patient Abuse Unit (MFPAU) investigates and prosecutes Medicaid provider fraud. Email ago.medicaid.fraud@nebraska.gov, call (800) 727-6432 or (402) 471-3549, or mail a completed form to the Office of the Attorney General, Attn: Medicaid Fraud and Patient Abuse Unit, 2115 State Capitol, Lincoln, NE 68509-8920.
Nevada
If you suspect Medicaid fraud in Nevada, submit a complaint by emailing mfcuintake@ag.nv.gov or writing a letter to the Office of the Attorney General, Medicaid Fraud Control Unit, 100 North Carson Street, Carson City, NV 89701.
New Hampshire
Report fraud in New Hampshire by calling NH Healthy Families Member Services at (866) 769-3085, the FWA Hotline at 1-866-685-8664, or writing to NH Healthy Families Compliance Department, 2 Executive Park Drive, Suite 220, Bedford, NH 03110.
New Jersey
To report Medicaid fraud in New Jersey, call (609) 292-1272. Alternatively, submit this form via fax to 609-292-7410 or mail it to the Medicaid Fraud Control Unit & Patient Abuse & Neglect Unit, P.O. Box 094, Trenton, New Jersey 08625.
New Mexico
In New Mexico, report Medicaid provider fraud by phone at (800) 228-4802 or email HSD-OIG.Fraud@HSD.NM.GOV. You can also mail the New Mexico Human Services Department, Office of Inspector General, 8909 Adams St. NE, Suite A, Albuquerque, NM 87113.
New York
File a Medicaid fraud allegation by completing an online form or a hard copy form and submitting it by mail to NYS OMIG Bureau of Fraud Allegations, 800 North Pearl Street, Albany, New York 12204, or by fax to (518) 408-0480.
North Carolina
Report Medicaid provider fraud in North Carolina to the Attorney General’s Medicaid Investigations Division at (919) 881-2320 or online through their website.
North Dakota
To report suspected Medicaid fraud in North Dakota, email medicaidfraud@nd.gov, call (800) 755-2604, or complete the Suspected Fraud Referral (SFN 20) form.
Ohio
To report medical provider fraud in Ohio, call (614) 466-0722 or visit the Attorney General’s office website to make an anonymous report to the Department of Medicaid.
Oklahoma
Report Medicaid fraud to the Office of Attorney General – Medicaid Fraud Control Unit at 313 NE 21st Street, Oklahoma City, OK 73105. You can also call (405) 521-3921 in Oklahoma City or (918) 581-2885 in Tulsa.
Oregon
If you suspect an Oregon Health Plan (Medicaid) provider is committing fraud, call 888-FRAUD01 (888-372-8301), complete this online form, or email opi.referrals@oha.oregon.gov.
Pennsylvania
In Pennsylvania, report suspected fraud to the Department of Human Services’ Office of State Inspector General. Call the Fraud Tip Hotline at (844) 347-8477.
Rhode Island
To report Medicaid fraud in Rhode Island, submit a form from this page or call (401) 222-2566 or (401) 274-4400, ext. 2269.
South Carolina
Report suspected fraud to South Carolina’s Division of Program Integrity by calling (888) 364-3224, emailing fraudres@scdhhs.gov, or mailing SC FRAUD HOTLINE, Division of Program Integrity, 1801 Main Street, P.O. Box 100210, Columbia, SC 29202-3210.
South Dakota
File a report with the Insurance Fraud Prevention Unit of the Division of Criminal Investigation by calling 605-773-3331 or emailing insurancefraud@state.sd.us.
Tennessee
Call the Toll-Free TennCare Provider Fraud Hotline at (833) 687-9611, email ProgramIntegrity.TennCare@tn.gov, complete the online form, or mail your written complaint to the Division of TennCare, Attn: Program Integrity Tip Department, 310 Great Circle Road, Nashville, TN 37243.
Texas
To report suspected Medicaid fraud, waste, and abuse in Texas, visit the Office of Inspector General’s website or call (800) 436-6184.
Utah
Contact the Utah Office of Inspector General by emailing mpi@utah.gov, calling (855) 403-7283, or visiting their website to report provider fraud, waste, or abuse.
Vermont
To report Medicaid fraud in Vermont, complete this form, call (802) 828-5511, or email ago.mfraureport@vermont.gov.
Virginia
Report Medicaid fraud allegations in Virginia by calling (866) 486-1971 or emailing recipientfraud@dmas.virginia.gov.
Washington
Report suspected Medicaid provider fraud in Washington by calling (833) 794-2345 or emailing hottips@hca.wa.gov.
West Virginia
In West Virginia, report Medicaid fraud by completing the online reporting form, calling 1-888-Fraud-WV (1-888-372-8398), or writing to Medicaid Fraud Control Unit, 100 Dee Dr., Suite 101, Charleston, WV 25311.
Wisconsin
Report fraudulent use of Medicaid in Wisconsin through the fraud hotline at (877) 865-3432 or the web portal.
Wyoming
Report suspected fraud to Wyoming’s Medicaid Fraud Control Unit by filling out the online form, mailing a completed paper form, emailing ag.medicaid.fraud@wyo.gov, or calling (800) 378-0345.
Speak to An Attorney About Your Case Today
If you or a loved one has been a victim of medical fraud, it is important to speak with an attorney who can explain your next steps. A lawyer who specializes in these cases can help you report the fraud and seek compensation for any financial losses or injuries you may have suffered as a result of the fraud.
Contact an attorney today to schedule a consultation and learn more about your legal rights and options.