Complaint Process

Complaint Process, Helping Beneficiaries, Caregivers and Family membersThe Virginia SMP Program provides help to beneficiaries, caregivers and family members when they are unable to resolve or report fraud- related inquiries and referrals regarding Medicare, Medicaid and other health care related consumer issues on their own.  SMPs have special permission to bypass CMS’s normal complaint reporting channels, and make direct referrals/complaints directly to Medicare Program Safeguard Contractors (OSCs) and MEDICs Medicare Drug Program Contractors) at CMS.

MEDIC’s and PSCs are responsible for investigating fraud claims to Medicare Parts A & B and to the Medicare drug program (Part D).  The contractors review complaints and, if necessary, make referrals to the Office of the Inspector General (OIG).  The OIG may seek criminal or civil prosecution, sanctions, penalties or refer the case to other law enforcement agencies or the Bureau of Investigations (FBI).  The FBI has jurisdiction over both Federal and private insurance programs.

 Virginia Complaints

SMP staff or SMP volunteers can explain how to submit the necessary forms in order to submit a complaint on your behalf.

The Virginia toll-free hotline number is 1-800-938-8885.

For issues that involve beneficiary identification numbers, you must fill out an SMP Waiver to permit SMP staff to resolve your complaint on your behalf, with your permission.  SMP staff will refer your complaint to an appropriate Medicare Contractor or the appropriate agency to resolve your complaint or report your complaint.

To Download Complaint Information Form:

To Report Health Care Fraud Directly to the Inspector General

HHS Tips@OIG.hhs.gov

Call 1-800-HHS-TIPS / 1-800-447-8477

TTY: 1-800-377-4950

Filing a Medicare Claim

If you need to submit a Medicare Claim yourself; you may find the following document from MyMedicare.gov (external website) helpful:

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