What Happens If I Know of Medicare Fraud and Don't Report It

Fight Medical Fraud What Happens If I Know of Medicare Fraud and Don't Report It

What Happens If I Know of Medicare Fraud and Don't Report It?

In legal terms, if you know Medicare fraud is occurring but don't report it, you're acting as an accessory after the fact. If you're employed as hospital staff or a nurse, you're acting unethically and unlawfully.

You also expose yourself to professional risk because you might be implicated when someone else reports Medicare fraud. You could lose your job, lose your nursing license, and damage your professional reputation. You might face hefty fines and even go to jail if the fraud is significant.

As a patient who suspects Medicare fraud but doesn't report it, you're a bad neighbor. You may not lose your job or go to jail, but you're contributing to fraud that costs fellow taxpayers $130 billion every year. It's an expensive problem that we can solve.

Can I Get a Reward for Reporting Medicare Fraud?

Yes. Whether you're a whistleblowing employee or a concerned patient, you should report health care fraud. The good news is that Medicare does offer rewards to individuals who report fraud once the case is closed. They don't disclose any precise amounts, but the Medicare website says the reward amount will reflect the money saved by stopping the fraudulent activity.

Signs of Medicare Fraud

How does one know if Medicare fraud is occurring? We'll cover some things to look for and document.

For Hospital Staff

Common signs of Medicare fraud include:

  1. Upcoding occurs when a Medicare services provider charges Medicare for more expensive services or a larger quantity of services than were provided. For instance, imagine a patient receiving one MRI and three physical therapy visits. The hospital bills Medicare for five MRIs and ten PT sessions. This is fraud.
  2. Prescription meds. Another instance of upcoding occurs when a hospital bills Medicare Part D for brand-name prescriptions but only supplies the less-expensive generic to the patient.
  3. Unbundling happens when a hospital bills Medicare for services individually rather than in a designated bundle.
  4. Upbundling occurs when Medicare is charged for a whole bundle of services, even though the patient only received part of that care.

Medical professionals aren't the only people who can help prevent Medicare fraud. This responsibility also lies with the patient and their contacts.

For the Patient, Their Families and Healthcare Proxies

Signs that a provider might be using you to rip off Medicare include:

  1. Random medical bills for services you didn't receive
  2. Fluffed-up bills for care that include extra services you never received
  3. Unbundling charges for individualized items that should be included in your hospital stay. For instance, charging you seven times for cable TV access rather than including cable TV in your total cost for the hospital stay.

Medical billing and coding are complicated, but that doesn't mean you should sit back and take the abuse. You can use DoNoPay to stand up to the biggest hospitals and healthcare organizations from the comfort of home.

Fight Medicare Fraud Now

If you know Medicare fraud is happening, whether you're a hospital employee or a patient, you can use DoNotPay to report it.

  • For patients, we can ensure you get medical bills fixed and prevent taxpayers from paying more fraudulent funds.
  • For staff, we can ensure your future licenses and reputation are protected.

As the world's first robot lawyer, we promise that all the forms will be done the first time correctly and kept confidential. That way, when your organization is investigated, you can prove that you weren't acting as an accessory to the fraud.

How to Report Medicare Fraud With DoNotPay

Just follow five easy steps.

  1. Search Fight Medical Fraud on DoNotPay.


  2. Tell us the date of your visit, what you were treated for, and where you were treated.


  3. Let us know what CPT code your visit was filed under. If you don't know, we'll generate a letter for you to send to your physician to request the code.


  4. Choose the correct CPT code or let us know if you want us to find it for you.


  5. And that's it! DoNotPay will automatically find the correct CPT code for your visit if you don't know it and then generate a demand letter on your behalf to send to your physician for a bill correction.


DoNotPay can help you write a demand letter for a bill correction to the fraudulent healthcare party. If the resolution is not to your liking, use DoNotPay's Sue Now product to begin a small claims suit.

Reporting Medicare Billing Fraud on Your Own

You can also report Medicare billing fraud by yourself. It's a hassle, and you'll need to keep excellent records. That way, you won't be charged as an accessory when the fraud comes to light later.

How to Report Medicare Fraud on Your Own
Call Medicare1-800-MEDICARE

or 1-800-633-4227

Contact the The U.S. Department of Health and Human Services – Office of the Inspector General1-800-368-1463

When you call, be sure to:

  • Identify yourself
  • Offer proof of the fraud
  • Keep track of the calls you make and the agent names
  • Ask for confidentiality

Ultimately, the fraud investigation can take a long time, like several months or even years. It depends on how long the fraud took place and how much money is involved. So don't expect immediate results.

Use DoNotPay When You Need to Fight Back

Whenever you think a big organization is taking advantage of you, turn to DoNotPay. We can help you stand up to big hotels, hospitals, and even the criminal justice system. Join DoNotPay today.

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