Reporting Abuse, Neglect and Fraud Against Healthcare Providers

United States Federal Government

Before you report neglect or abuse, you should call our office to find out the best way to proceed. In some situations, reporting abuse or neglect to certain agencies will not only result in no action being taken, but a shoddy investigation could result in the facility being exonerated. In addition, the manner in which you report information, including the facts being communicated to the investigator, can have a significant impact on the outcome of the investigation.

A. Reporting Nursing Home Abuse to the Feds, CMS

The U.S. Health and Human Services Administration on Aging provides home and community-based services and opportunities to older persons and their caregivers through programs funded under the Older Americans Act.

Administration for Community Living

• The Administration for Community Living oversees the implementation and coordination of disability programs, policies and special initiatives for persons with disabilities.

B. Medicare Fraud

Calling us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
If you’re in a Medicare Advantage Plan, call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379).

Have this information before you report fraud:

Your name and Medicare Number.
The provider’s name and any identifying information you may have.
The service or item you’re questioning and when it was supposedly given or delivered.
The payment amount approved and paid by Medicare.
The date on your Medicare Summary Notice or claim.
Centers for Medicare & Medicaid Services

C. Medicare Beneficiaries: What to do if you have an inquiry or complaint

If you need help with a Medicare-related inquiry, there are several ways you can get help.

Call your plan. If your inquiry is related to your Medicare Part D or Medicare Advantage (Part C) plan, contact your plan first using the phone number on your plan member ID card. Your plan is the best resource to resolve plan related issues.

Call 1-800-MEDICARE. Call 1-800-633-4227, TTY users should call 1-877-486-2048. If your concern is related to Original Medicare, or if your plan was unable to resolve your inquiry, contact 1-800-MEDICARE for help.

Contact the SHIP. The State Health Insurance Assistance Programs (SHIPs) are state programs that provide free local health insurance counseling to people with Medicare regarding their benefits, coverage, appeals and complaints. Find your local SHIP here.

D. Contact the Medicare Beneficiary Ombudsman (MBO).

If you have been unable to resolve your concern with your plan or 1-800-Medicare, ask a 1-800-MEDICARE representative to submit your complaint or inquiry to the MBO. The MBO will help to ensure that your inquiry is resolved appropriately.
In 2003, Congress established the MBO position to assist Medicare beneficiaries with their inquiries, complaints, grievances, appeals, and requests for information. The MBO is charged with supporting CMS’ customer service and administration efforts by receiving and responding to beneficiary and other stakeholder inquiries and complaints, working with patients to provide outreach and education to beneficiaries, and providing suggestions for improving the administration of Medicare. See the Downloads section of this page for links to the published reports.

 

Free Consultation:

If you require more information on reporting, or a loved one has been abused or neglected, call us for a free consultation free consultation.

Law Office of Jeffrey J. Downey, PC
8270 Greensboro Drive, Suite 810
McLean, VA 22102
Phone: 703-564-7318
Email: jdowney@jeffdowney.com
On the web at www.jeffdowney.com