Report Fraud

• used medical supplies, diagnostic equipment or research devices
• used personal care products
• medical waste (including sharps such as needles/lances)
• biological products or clinical specimens

See U.S. Postal Service Domestic Mail Manual 610.8 (Nonmailable & Restricted Articles) & 10 (Hazardous Materials). Details with supporting information may be included in narrative form as part of the OIG Hotline complaint. A violation of 18 U.S.C. § 1716 governing nonmailable items is a crime punishable by fine, imprisonment or both.

Most tips fall in the following categories:

• crimes or gross misconduct committed by HHS employees/contractors,
• conflicts of interest on the part of Department employees,
• cost overruns in HHS programs/initiatives due to mismanagement,
• false applications for Department contracts/grants,
• failure to provide the services/products for HHS grants/contracts,
• false/Fraudulent claims submitted to Medicare/Medicaid,
• kickbacks/inducements for referrals by Medicare/Medicaid providers,
• medical Identity Theft involving Medicare and/or Medicaid Beneficiaries,
• door-to-door solicitation of Medicare/Medicaid beneficiaries,
• misrepresentation of Medicare private plans,
• failure of a hospital to evaluate and stabilize an emergency patient,
• abuse/neglect in nursing homes and other long term care facilities,
• failure to pay child support (limited to interstate cases) - cases where the parent ordered to pay support is in a different state than the child, and
• fraud/Waste in American Recovery and Reinvestment Act grants

Tips not typically forwarded after OIG review include:

• contact the Office of the Secretary here,
• allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference (contact your agency's Equal Employment Opportunity officer.),
• appeals of administrative decisions made by HHS agencies/contractors, including Medicare payment decisions and contract/grant awards (consult the guidelines for the particular program.),
• appeals of judicial decisions by State/Federal courts involving HHS programs (contact the court that issued the decision),
• complaints of failure to safeguard medical information, i.e. HIPAA violations (contact the HHS Office for Civil Rights),
• customer service complaints involving Department employees/contractors (contact: Management of the relevant agency.),
• Social Security disability fraud (contact the Social Security Administration OIG),
• failure to pay child support (intrastate cases - cases where the parent ordered ot pay support is in the same state as the child) (contact the court that issued the child support order.),
• allegations of identity theft unrelated to HHS programs (Contact the Federal Trade Commission)

No, you do not have to identify yourself. However, the agency tasked with evaluating your complaint may have further questions, so it will help our review if you provide your name and contact information.

As provided for in the provisions of Federal Whistleblower protections, if you are an employee of HHS, we will not release your name to non-OIG personnel without your permission unless it is determined that such disclosure is unavoidable during an investigation.

If you are not an HHS employee, the Hotline may share your personal information with HHS employees or contractors for the sole 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 for the source prevents a comprehensive review of the complaint.

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.

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 OIG Hotline is not authorized to disclose any information on records in its possession: 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.