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Reporting Fraud

Reporting of Potential Fraud, Waste or Abuse Regarding Medicare Part D Plans

The Medicare Prescription Drug benefit was implemented by the Centers for Medicare and Medicaid Services (CMS) to allow all Medicare beneficiaries access to prescription drug coverage beginning on January 1, 2006.

Medicare is interested in receiving reports of potential fraud, waste or abuse from Medicare beneficiaries. Examples of these types of complaints may include:

  • An individual or organization pretends to represent Medicare and/or Social Security, and asks you for your Medicare or Social Security number, bank account number, credit card number, money, etc.
  • Someone asked you to sell your Medicare prescription drug card.
  • Someone asked you to get drugs for them using your Medicare prescription drug card.
  • You feel a Medicare prescription Drug Plan has discriminated against you, including not letting you sign up for their plan because of your age, health, race, religion, income.
  • You were encouraged to disenroll from your plan.
  • You were offered cash to sign up for a Medicare prescription drug plan.
  • You were offered a gift worth more than $15 to sign up for a Medicare prescription drug plan.
  • Your pharmacy did not give you all of your drugs and had no plans to provide the drugs to you for your prescription at a later time.
  • You were billed for drugs that you didn’t receive.
  • You believe that you have been charged more than once for your premium costs.
  • Your Medicare prescription drug plan did not pay for your covered drugs.
  • You received a different drug than your doctor ordered and your doctor did not allow substitution.

Please contact Medicare at 1-800-MEDICARE (1-800-633-4227) to report complaints about one of these types of fraud, waste, and abuse issues or a related complaint.

If you have a general question or concern related to your Medicare drug benefit and it is not a potential fraud, waste or abuse issue, please contact the HOP Administration Unit at 1-800-773-7725 or call 1-800-Medicare.

 

Last modified November 10, 2020