How to Report Fraud, Waste, and Abuse: Methods, Contacts, Requirements

When you suspect fraud, waste, or abuse, acting promptly helps protect public funds and program integrity. This guide shows you where to report, which method to use, and what each channel typically requires so your submission is complete on the first try.

Whether you contact an Office of Inspector General Hotline, a state Medicaid Fraud Control Unit, or a private plan’s compliance office, the essentials are the same: provide specific facts, preserve evidence, and follow the correct procedure for the agency or program involved.

Reporting to Federal Inspector General Offices

Most federal departments and major programs have an Inspector General (IG) that investigates misconduct, mismanagement, and fraud. If federal funds, grants, contracts, or benefits are involved, start here. You can submit tips via an Office of Inspector General Hotline online, by phone, or by mail.

When to choose an IG

• Allegations tied to federal benefits or grants (for example, healthcare billing to Medicare or TRICARE, procurement fraud on a federal contract, or misuse of grant funds).
• Misconduct by federal employees or contractors performing federal work.
• Program integrity issues within a specific federal department (e.g., HHS, DoD, DHS, VA).

What to include

• Who, what, when, where, and how: full names, roles, dates, locations, dollar amounts, schemes used, and specific rules you believe were violated.
• Documentation: invoices, claims, timesheets, emails, photos, or logs that show the issue.
• Your availability for follow-up and your confidentiality preference; many IGs allow anonymous tips, but detailed contact information can help investigators.

IG hotlines typically acknowledge your report and may issue a tracking or reference number. Ask about Fraud Reporting Confidentiality options if you fear retaliation.

Contacting State Fraud Hotlines

For state-level programs or activities, your best path is your state’s fraud reporting channels. State Fraud Investigations are usually handled by the Attorney General, State Auditor/Comptroller, or sector-specific units.

Key state contacts

• Medicaid Fraud Control Unit (MFCU) for provider billing schemes, patient neglect/abuse in facilities, or kickbacks tied to Medicaid.
• State unemployment insurance fraud units for wage or identity fraud related to UI benefits.
• State procurement, tax, insurance, or workers’ compensation fraud hotlines for sector-specific issues.

What to prepare

• Program details (e.g., Medicaid ID, claim numbers, dates of service) and a concise narrative of what occurred.
• Any correspondence with state agencies, plus names of officials you contacted and outcomes.
• Your preference for anonymity or confidential handling, recognizing that some states require contact information for certain case types.

Using Online Reporting Forms

Online portals are the fastest way to submit a well-structured report and upload evidence. Many federal and state agencies, as well as private plans, use guided forms that mirror Compliance Reporting Procedures.

Common fields you will see

• Your relationship to the matter (employee, contractor, beneficiary, competitor, patient, caregiver, or concerned citizen).
• Subject details: names, addresses, identifiers (NPI/provider number, plan ID, grant or contract number), and organizational affiliations.
• Incident specifics: dates, locations, transaction identifiers, claim numbers, dollar values, and how you discovered the issue.
• Impact: financial loss, safety risks, or program harm; note any ongoing risk requiring urgent action.
• Attachments: permissible file types and size limits; use clear filenames and short descriptions.

Submission tips

• Draft your narrative offline first to avoid timeouts, then paste it into the form.
• Upload only legible, relevant documents. Redact sensitive personal data that is not needed.
• Save or print the confirmation page and case number for your records.

Mailing Written Complaints

Mail remains useful when you need to submit a signed statement, large exhibits, or when a program requires it. A well-organized packet speeds triage and review.

How to structure your letter

• Header: your name and contact information (optional if you wish to remain anonymous), date, and the agency or program you are reporting.
• Subject line: “Fraud, Waste, and Abuse Report – [Program/Entity Name].”
• Concise narrative: who did what, when, where, how, why it matters, and what evidence supports it.
• Exhibit list: label attachments (Exhibit A, B, C) and reference them in your narrative.
• Statement of truth: a short declaration that the information is true to the best of your knowledge.

Mailing best practices

• Use a trackable mail service and keep copies of everything you send.
• Place sensitive materials in sealed inner envelopes labeled “Confidential.”
• Do not send originals you cannot replace; provide copies and retain the originals for potential collection.

Calling Dedicated Fraud Hotlines

Dedicated lines such as a Fraud Waste Abuse Hotline are effective when a situation is time-sensitive or when you prefer to speak with an intake specialist. Many hotlines accept anonymous tips and operate extended hours.

How to prepare for the call

• Outline key facts and have documents in front of you to answer specific questions quickly.
• If anonymity matters, avoid calling from a work phone or network traced to the subject.
• Ask at the start about confidentiality, case number issuance, and whether calls are recorded.

During and after the call

• State facts in chronological order and avoid speculation; if you do not know an answer, say so.
• Request the case or reference number and any next steps you should expect.
• Immediately write a call summary with date, time, and the specialist’s first name or ID.

Following Agency-Specific Procedures

Different programs require different reporting paths. Following the right Compliance Reporting Procedures prevents delays and preserves your rights. Examples include healthcare plans, defense contractors, universities, and grant recipients.

Healthcare examples

• Medicare Advantage Fraud Reporting: plan sponsors maintain compliance hotlines and online portals for suspected upcoding, risk score gaming, phantom services, or marketing misconduct.
• Medicaid managed care: report to the plan’s compliance office and, for provider fraud or patient harm, to the state’s Medicaid Fraud Control Unit.

Grants, contracts, and universities

• Federal grant recipients and contractors typically have internal hotlines plus obligations to report certain misconduct externally (e.g., to an IG or contracting officer).
• Universities and research institutions maintain research integrity and compliance offices for misuse of funds, data fabrication, or effort reporting issues.

Workplace channels

• If the organization has a compliance hotline or ethics portal, use it in addition to external reporting when appropriate.
• Retain proof of your submission; internal reports can demonstrate good-faith effort and aid coordination with authorities.

Submitting Documentation and Evidence

Clear, admissible evidence strengthens your report. Submit only what you lawfully possess and that directly supports your claims.

Evidence checklist

• Transactional records: claims, invoices, EOBs, timesheets, purchase orders, contracts, and ledgers with dates and amounts.
• Communications: emails, messages, letters; include headers or metadata where possible.
• Witness information: names, roles, and how each person can confirm specific facts.
• Timelines: a simple chronology connecting events, documents, and decision points.
• Media: photos or scans that are clear and date-stamped; avoid altering images.

Formatting and security

• Use searchable PDFs when possible; label files logically (e.g., “Exhibit_A_Invoice_2025-03-10.pdf”).
• Redact nonessential sensitive data (SSNs, full DOBs) before sharing; keep an unredacted set in case investigators request it.
• Preserve originals and avoid edits that change metadata; keep a chain-of-custody note for physical items.
• Do not obtain evidence illegally or violate privacy laws; when in doubt, describe the item and ask the agency how to proceed.

Follow-up and outcomes

• Keep your case number and check for requests for additional information.
• Be patient; complex fraud cases can take months. You may not receive detailed updates due to confidentiality rules.
• If retaliation is a concern, document events and consider seeking advice on protections available under whistleblower laws.

Conclusion

Effective fraud, waste, and abuse reporting hinges on choosing the right channel, supplying concrete facts, and organizing your evidence. By following the procedures outlined above—federal IGs, state hotlines, online forms, mail, and dedicated hotlines—you improve your chances of a swift, thorough investigation.

FAQs

What information is required to report fraud, waste, and abuse?

Provide the essentials: who is involved, what happened, when and where it occurred, how the scheme works, and why it violates rules. Add precise identifiers (claim numbers, contract or grant numbers, NPIs, plan IDs), dollar amounts, and a clear timeline. Attach supporting documents and state whether you can be contacted for follow-up.

How can I report fraud anonymously?

Most hotlines and online portals accept anonymous submissions. If anonymity is critical, avoid work devices or networks and do not include identifying details in your narrative or attachments. You can still request a case number. If you choose to share your identity, ask about Fraud Reporting Confidentiality options that restrict disclosure to investigators.

Where can I find specific fraud reporting contacts for my state?

Check your state’s Attorney General or State Auditor website for fraud hotlines and reporting portals, and look for the Medicaid Fraud Control Unit for Medicaid-related issues. Many state agencies also list program-specific hotlines (unemployment insurance, tax, insurance, or workers’ compensation) on their public pages.

What happens after I report suspected fraud?

Your report is triaged to determine jurisdiction and priority. Investigators may request more details, open an inquiry, or refer the matter to the proper office. You might not receive case updates due to confidentiality rules, but you can typically use your reference number to confirm receipt and provide additional evidence if requested.