Report Fraud

Most complaints fall in the following categories:

• Crime, gross misconduct, or conflicts of interest involving HHS employees/contractors,
• Fraud, waste, or abuse relating to HHS Grants/Contracts, including American Recovery and Reinvestment Act (ARRA) grants,
• False/Fraudulent claims submitted to Medicare/Medicaid,
• Kickbacks/inducements for referrals by Medicare/Medicaid providers,
• Medical Identity Theft involving Medicare and/or Medicaid Beneficiaries,
• Failure of a hospital to evaluate and stabilize an emergency patient,
• Abuse/neglect in nursing homes and other long term care facilities,

Complaints not addressed through the OIG Hotline include:

• Allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference (please contact your agency's Equal Employment Opportunity officer),
• Allegations by employees or applicants concerning prohibited personnel practices; non-ARRA whistleblower retaliation; or Hatch Act violations (please contact the US Office of Special Counsel ),
• Appeals of administrative decisions made by HHS agencies/contractors, including Medicare payment decisions and contract/grant awards (please consult the guidelines for the particular program),
• Appeals of judicial decisions by Federal or state courts involving HHS programs (please contact the court that issued the decision ),
• Complaints of failure to safeguard medical information, i.e. HIPAA violations (please contact the HHS Office for Civil Rights ),
• Customer service complaints involving HHS employees/contractors (please contact management of the relevant agency),
• Fraud relating to Social Security (please contact the Social Security Administration OIG ),
• Allegations of identity theft unrelated to HHS programs (please Contact the Federal Trade Commission ),

No, you do not have to identify yourself. All complaints submitted to the Hotline are treated confidentially. Complaints are shared only within HHS for the purpose of evaluating your complaint; public disclosure of personally identifiable information is restricted by the Privacy Act.

If you prefer, you may provide your complaint anonymously. In many cases, however, the lack of contact information prevents a comprehensive review of the complaint and will prevent further communication between you and HHS OIG. If you wish to enter your complaint anonymously, please take care to withhold any personally identifiable information from your complaint narrative and from any attachments.

Whistleblower Protection: OIG Hotline Operations will provide anyone protected under Federal whistle blower statutes the protections required under law.

To the best of your ability, please provide the following information when contacting the Hotline

Type of complaint:

• fraud/waste involving American Recovery and Reinvestment Act funds
• crime/misconduct/mismanagement by HHS employee/official
• contractor fraud
• grants fraud
• billing Medicare/Medicaid for services not provided
• kickbacks/inducements by healthcare providers
• failure of healthcare providers to meet business requirements for participation in Medicare/Medicaid
• direct solicitation of Medicare/Medicaid beneficiaries
• failure of a Medicare private plan to provide contracted Service
• abuse/neglect of nursing home residents
• failure to pay child support
• false application for an HHS-funded assistance program
• other (please explain in your narrative description)

HHS program being affected by your allegation

• Office of the Secretary
• Centers for Medicare & Medicaid Services
• Traditional Medicare (Parts A and B)
• Medicare Advantage Plan (Part C)
• Medicare Prescription Drug Program (Part D)
• Medicaid
• Administration for Children & Families
• Temporary Assistance to Needy Families
• Head Start
• Office of Child Support Enforcement
• Indian Health Service
• National Institutes of Health (please specify which Institute in your narrative description)
• Centers for Disease Control and Prevention
• Food and Drug Administration
• Administration on Aging
• Agency for Healthcare Quality and Research
• Agency for Toxic Substances and Disease Registry
• Healthcare Resources and Services Administration
• Substance Abuse and Mental Health Services Administration
• US Public Health Service Commissioned Corps
• Other (please explain in your narrative description)

Unless you choose to remain anonymous please provide the following data. If you are submitting your complaint anonymously, please take care to withhold personally identifiable information.

• Your Name
• Your Street Address
• Your City/County
• Your State
• Your Zip Code
• Your Telephone Number(s)
• Your email Address

Subject/Person/Business/Department that allegation is against:

• Name of Subject
• Title of Subject (if applicable)
• Subject's Street Address
• Subject's City/County
• Subject's State
• Subject's Zip Code
• Subject's Telephone Number(s)
• Subject's email address/website

Narrative:
Your comments need not be exhaustive but should include sufficient detail for a basic analysis of the complaint.

In addition to explaining the nature, scope, and time frame of the activity in question, please be sure you address the following questions (as appropriate):

• How you are aware of the alleged activity?
  • Have you already reported the fraud, waste, and/or abuse? If so, to whom?
  • Have you suffered retaliation for reporting this activity? If so, explain.
• Do you know of any potential witnesses to the activity?
• Do you have any documents or other physical evidence in your possession? (You may attach samples to your complaint but please do not send original documents — Items submitted will not be returned to you.)

If you are reporting a suspicious charge from a Medicare Summary Notice, please include a copy of the Notice.

An OIG analyst will review your complaint for relevance and completeness. Not all complaints result in an investigation.

If you have identified yourself, a reviewing official may contact you for further information.

The Hotline will not be able to confirm receipt of your complaint or respond to any inquiries about action taken on your complaint. We understand the natural inclination to follow up on a report but the OIG does not provide the status of complaints.

You have the option, however, of requesting records through the OIG Freedom of Information Act officer. Remember to phrase your request in terms of a search for records pertinent to your complaint, not status. You should wait at least six months before filing such a request.

If your purpose in filing a complaint is in part to gain some type of relief — such as obtaining a refund from a Medicare-participating provider or qualifying for benefits from an HHS-funded program — we strongly advise that you pursue other administrative or judicial remedies. OIG rarely intervenes in personal or civil grievances.