How to Report Potential Fraud, Waste, and Abuse (FWA): Approved Channels

Knowing how to report potential fraud, waste, and abuse empowers you to protect patients, programs, and public funds. This guide explains the approved channels and what to include so your tip is actionable and aligned with Fraud Waste and Abuse Compliance expectations.

Before you submit a report, gather details that help investigators act quickly:

• Who was involved (names, roles, provider or facility, plan, or program).
• What happened (suspected scheme, codes or services, dollar amounts, claim numbers if known).
• When it occurred (specific dates or date ranges).
• Where it occurred (site of care, state, or platform).
• How you learned about it and any evidence you can share.
• Your preference for confidentiality or using Anonymous Reporting Channels.

Reporting to HHS Office of Inspector General

The HHS Office of Inspector General investigates fraud affecting Medicare, Medicaid, and other HHS programs. You can submit tips to the Office of Inspector General Hotline by phone, online form, or mail, and you may choose to remain anonymous or request confidentiality.

Make your submission clear and specific. Provide claim identifiers, provider numbers, and supporting documents when available, but share only the minimum necessary patient information. Note any ongoing harm or imminent risk to patients so the OIG can prioritize the case.

• State the suspected scheme (for example, phantom billing, upcoding, or kickbacks).
• Include dates, amounts, CPT/HCPCS/DRG codes, and beneficiary or provider identifiers if known.
• Describe patterns (repeated services, unusual volumes, or geographic clustering).
• Indicate whether you can be contacted for follow-up and how.

Reporting to State Medicaid Agencies

Each state’s Medicaid agency accepts tips about provider misconduct, improper payments, and beneficiary fraud. These agencies often have Program Integrity units and may handle administrative recoveries or refer criminal matters to investigators.

If you are unsure where to start, consult your state’s official site or the State Medicaid Contact Database to locate phone, email, and online portals. Explain the issue, identify the managed care plan if applicable, and note whether the conduct spans multiple states or providers.

• Provide the provider’s Medicaid ID, NPI, or facility name if available.
• Attach or describe evidence (remittance advice, EOBs, records excerpts).
• Clarify whether patients were billed, balance-billed, or harmed.
• Ask whether your state allows anonymous submissions and how follow-up works.

Reporting to State Medicaid Fraud Control Units

Medicaid Fraud Control Units (MFCUs), usually within state Attorneys General offices, investigate criminal Medicaid fraud and patient abuse or neglect in facilities. Contact your MFCU when you suspect intentional schemes, organized activity, or resident harm.

When reporting to an MFCU, highlight criminal red flags and quantify losses. Note whether records may be altered or if there is a risk of retaliation, and identify witnesses who can corroborate events.

• Describe the alleged crime (billing for services not rendered, falsified records, kickbacks).
• Specify facilities involved and whether the conduct crosses county or state lines.
• Include patient safety concerns, especially in long-term care settings.
• Mention parallel reports you made to the state Medicaid agency or HHS OIG.

Reporting to VA Integrity and Compliance Helpline

For concerns within the Department of Veterans Affairs health system, employees, contractors, and partners can use the VA Integrity and Compliance Helpline or a local Healthcare Compliance Helpline. These channels address procurement risks, documentation integrity, billing issues, and conflicts of interest.

State what makes the conduct noncompliant and how it affects veterans, resources, or safety. Ask about confidentiality and non-retaliation policies, and keep any case numbers for future reference.

• Identify the VA facility, service line, vendors, and contracts implicated.
• Attach supporting documents or describe where they are stored.
• Flag urgent patient safety or privacy risks for immediate triage.
• Request instructions for secure evidence transfer if needed.

Reporting to VA Office of Inspector General

The VA Office of Inspector General investigates fraud involving VA programs, benefits, procurement, and patient care. You can submit tips through the Office of Inspector General Hotline, with options for anonymity or confidentiality.

Focus on facts that establish intent and impact. If you previously informed local leadership or compliance, include dates and outcomes so the OIG can assess response and potential escalation.

• Summarize the scheme and financial loss or patient harm.
• List contracts, purchase orders, or claim identifiers tied to the allegation.
• Provide names, roles, and potential witnesses.
• Share any internal case numbers or prior report references.

Reporting to Health Plan Special Investigations Units

Commercial insurers and Medicare Advantage or Medicaid managed care plans operate Special Investigations Units (SIUs) to detect and stop fraud. Special Investigations Unit Reporting is appropriate when a plan is directly affected by suspect claims or prior authorizations.

Members, providers, and employees can report via plan hotlines, portals, or dedicated emails. Include plan ID numbers, claim dates, and EOB details so the SIU can trace transactions quickly.

• Describe the pattern (unbundling, upcoding, medically unnecessary services).
• Identify the billing provider, rendering clinician, and facility.
• Attach redacted statements or screenshots supporting the allegation.
• Note whether law enforcement or other agencies have been notified.

Reporting via Compliance Hotlines and Email

Hospitals, health systems, and large practices maintain compliance hotlines and inboxes to capture concerns early. Using a Healthcare Compliance Helpline can stop problems before they escalate and demonstrates a good-faith effort to follow internal policy.

Check your organization’s policy for preferred channels and what to include. If you choose to remain anonymous, provide enough detail for triage and indicate where corroborating records can be found.

• Provide dates, departments, patient impact, and financial exposure.
• Explain prior internal notifications and any retaliation concerns.
• Ask for a tracking number and expected follow-up timelines.
• Avoid transmitting unnecessary protected health information.

Utilizing Online Reporting Platforms

Most agencies and plans offer secure portals to submit FWA tips and upload documents. Use only official websites, verify that the address is correct, and save any confirmation numbers for your records.

Strong online submissions are concise, factual, and well-organized. Group evidence by incident, label files clearly, and state whether you also reported to other authorities to prevent duplicate investigations.

• Confirm the portal supports Anonymous Reporting Channels if you prefer anonymity.
• Upload only relevant, lawfully obtained evidence; avoid sensitive data you are not authorized to share.
• Summarize the core allegation in one paragraph, then list supporting facts.
• Retain copies of what you submitted and note the date and time.

Across all channels, clear facts, specific dates, and well-organized evidence make your report actionable. When in doubt, submit to one appropriate authority and note any cross-reporting to ensure coordination.

FAQs

What are the primary methods to report healthcare fraud?

You can report through the HHS Office of Inspector General Hotline, your State Medicaid Agency, State Medicaid Fraud Control Units, VA Integrity and Compliance Helpline or VA Office of Inspector General, health plan Special Investigations Units, organizational compliance hotlines, and official online reporting platforms.

How can I report FWA anonymously?

Many hotlines and portals offer Anonymous Reporting Channels. Select the anonymous option or submit by mail without identifying information. Consider confidential reporting if you want protections and follow-up while limiting disclosure of your identity.

Which agencies handle Medicaid fraud reports?

HHS OIG and State Medicaid Agencies both accept tips, while Medicaid Fraud Control Units investigate criminal Medicaid fraud and patient abuse in facilities. Managed care plans’ SIUs also investigate fraud affecting their members and networks.

Where can I find contact information for state Medicaid fraud units?

Use your state’s official Medicaid website or the State Medicaid Contact Database to locate the appropriate phone numbers, emails, and online portals. You can also check your State Attorney General’s site for the MFCU contact page.