Jane Dotson
Insurance fraud can be reported in several ways, depending on the type of fraud and your location. Most states have fraud bureaus that accept reports of insurance fraud, and you can also report scams by doctors, chiropractors, and dentists to state medical boards. If you suspect a criminal act, such as filing a false insurance claim or selling fake policies, you can file a fraud report. You can also use the National Association of Insurance Commissioners Online Fraud Reporting System or contact the NICB directly to investigate crimes against coverage, such as auto, home, liability, and workers' compensation.
| Characteristics | Values |
|---|---|
| Report insurance fraud directly to a state fraud bureau | Use the National Association of Insurance Commissioners Online Fraud Reporting System |
| Contact state fraud bureau | Most states have fraud bureaus |
| NICB investigates crimes against coverage | Auto, home, liability, and workers' compensation. TEL-NICB 1-800-835-6422 or report scams online |
| Contact state medical boards to report scams by doctors, chiropractors, and dentists | MEDICARE 1-800-MEDICARE or go online to report scams. MEDICAID 1-800-HHS-TIPS or go online |
| National Flood Insurance Program | 1-800-323-8603 or go online |
| Federal Crop Insurance Program | 1-800-424-9121 or go online |
| TRICARE | 1-866-773-0404 or go online |
| Affordable Care Act | 1-800-318-2596 or go online |
| Provide full details of the suspected scam | Dates, names, phone numbers, emails, and URLs of suspected individuals and organizations |
| File a fraud report if you suspect a criminal act | Filing a false or padded insurance claim, selling insurance without a license, or selling fake policies |
| If you work in the insurance industry or on a special investigative unit | Use the insurance industry fraud reporting system |
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What You'll Learn
Contact a state fraud bureau
To report insurance fraud directly to a state fraud bureau, you can use the National Association of Insurance Commissioners Online Fraud Reporting System. Most states have fraud bureaus.
State fraud bureaus investigate crimes against specific types of coverage. For example, if you want to report suspected auto or home insurance fraud, you can contact the National Insurance Crime Bureau (NICB) via their hotline—1-800-835-6422—or report scams online. If you want to report suspected scams by doctors, chiropractors, or dentists, contact the relevant state medical boards. For example, you can report Medicare scams by calling 1-800-MEDICARE or going to their website. Similarly, you can report suspected Medicaid fraud by calling 1-800-HHS-TIPS or reporting it online.
Other examples of state fraud bureaus and their contact details include the National Flood Insurance Program (1-800-323-8603), the Federal Crop Insurance Program (1-800-424-9121), TRICARE (1-866-773-0404), and the Affordable Care Act (1-800-318-2596). When reporting suspected insurance fraud, it is helpful to provide as many details as possible, including dates, names, phone numbers, emails, and URLs of suspected individuals and organizations.
In addition to reporting fraud to state fraud bureaus, some states also provide resources to help you determine if you should file a complaint or report fraud. For example, in Texas, you can call the Help Line at 800-252-3439, Monday to Friday, 8 a.m. to 5 p.m. Central time, to get help deciding if you should file a complaint or report fraud. Generally, you would file a complaint if you disagree with a claim denial or the amount your insurance company is paying. On the other hand, you would file a fraud report if you suspect a criminal act, such as filing a false or padded insurance claim, selling insurance without a license, or selling fake policies.
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Report scams by medical professionals
If you suspect a medical professional of insurance fraud, you can report it to your state fraud bureau. Most states have fraud bureaus that investigate crimes against insurance coverage. You can also contact state medical boards to report scams by doctors, chiropractors, and dentists. Here are the contact details for some of the state medical boards:
- Medicare: 1-800-MEDICARE (1-800-633-4227) or report Medicare fraud online.
- Medicaid: 1-800-HHS-TIPS or go online.
- National Flood Insurance Program: 1-800-323-8603 or go online.
- Federal Crop Insurance Program: 1-800-424-9121 or go online.
- Tricare: 1-866-773-0404 or go online.
- Affordable Care Act: 1-800-318-2596 or go online.
When reporting suspected fraud, it is helpful to have as much information as possible, including dates, names, phone numbers, emails, and URLs of suspected individuals and organizations.
In addition to state fraud bureaus and medical boards, you can also report fraud by medical professionals to the Office of Inspector General (OIG) Hotline within the U.S. Department of Health and Human Services. The OIG Hotline accepts tips and complaints about potential fraud, waste, abuse, and mismanagement in the department's programs, including Medicare and Medicaid. However, due to the high volume of complaints received, not every submission results in an investigation.
For New York State, the New York State Board for Professional Medical Conduct handles problems regarding professional conduct among medical professionals, including physicians, medical residents, physician assistants, and specialist assistants. Any person can and should report fraudulent behavior to this board. After a complaint is filed, the Department of Health will investigate and, if fraud is suspected, present the matter to the Board. If the Board determines that the complaint describes fraudulent practice, charges will be filed, and a hearing will be scheduled.
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File a complaint vs. report fraud
When deciding whether to file a complaint or report fraud, it is important to understand the distinction between the two. A complaint typically involves a dispute or disagreement with an insurance company, bank, or other financial institution, whereas reporting fraud involves suspected criminal activity or unethical behaviour. Here are some detailed guidelines on when and how to file a complaint or report fraud:
Filing a Complaint:
- Disputes and Disagreements: File a complaint if you disagree with a claim denial or the amount your insurance company is paying. This includes coverage issues, claim disputes, premium problems, policy cancellations, or refunds.
- Financial Services: Complaints can be filed against a variety of financial institutions, including insurance companies, banks, mortgage lenders, and student loan servicers.
- Documentation: When filing a complaint, be prepared to provide relevant documentation such as letters, invoices, and advertising materials that support your case. Keep copies of all written communications and document your phone calls, including dates, names, and summaries of conversations.
- Resolution: Clearly state your complaint and the resolution you expect from the company. Sending a written dispute encourages a written response. If you are not satisfied with the response, you can escalate the complaint to the appropriate regulatory body.
Reporting Fraud:
- Suspected Criminal Acts: Report fraud if you suspect criminal activity, such as filing a false or padded insurance claim, selling fake insurance policies, or selling insurance without a license.
- Internal Fraud: If you work in the insurance industry and suspect internal fraud, waste, or abuse, report it immediately to the relevant internal audit office or state auditor's office.
- Anonymous Reporting: You can often report insurance fraud anonymously through state fraud bureaus or specialised organisations like the National Association of Insurance Commissioners (NAIC) or the National Insurance Crime Bureau (NICB).
- Evidence: When reporting fraud, provide as much information and evidence as possible, including dates, names, phone numbers, emails, and URLs of suspected individuals or organisations involved in the fraudulent activity.
Remember, filing a complaint is appropriate when you have a dispute or disagreement with a financial institution, while reporting fraud involves suspected unethical or criminal behaviour. Both processes are important to uphold ethical standards and protect consumers from fraudulent activities.
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Report internal fraud
If you suspect or have evidence of internal fraud related to insurance staff or operations, it's important to report it immediately through the appropriate channels. Here are some steps to follow:
- Contact the Relevant Authorities: Most states have fraud bureaus that are dedicated to investigating insurance fraud. You can contact your state fraud bureau anonymously to report your suspicions. They will be able to guide you on the specific procedures and may have online reporting systems or specific hotlines for different types of insurance fraud.
- Provide Detailed Information: When reporting suspected internal fraud, it's important to provide as much detailed information as possible. This includes dates, names, phone numbers, email addresses, and URLs of any individuals or organizations you suspect are involved. Specific details can help the authorities in their investigation.
- Use Designated Reporting Systems: If you work in the insurance industry, you should use the designated insurance industry fraud reporting system. This system is designed to facilitate the reporting of internal fraud and can be accessed online or through dedicated hotlines.
- Report to Internal Audit Offices: Depending on the specific insurance entity, you may be able to report internal fraud to an internal audit office. For example, if you suspect fraud related to TDI staff or operations, you can report it to TDI's Internal Audit Office by emailing [email protected]. Such offices are responsible for investigating and addressing internal misconduct.
- Maintain Your Privacy: When reporting fraud, it's essential to protect your privacy and safety. Utilize secure websites that use HTTPS certificates to ensure your connection is safe. State government websites generally value user privacy, so you can rest assured that your report will be handled discreetly.
- Report Other Types of Fraud: Insurance fraud can take many forms, and it's important to be aware of the different avenues for reporting various types of scams. For example, if you suspect scams by medical professionals like doctors, chiropractors, or dentists, you can contact state medical boards or report them to programs like Medicare or Medicaid.
Remember, reporting suspected internal insurance fraud is a crucial step in maintaining the integrity of the industry and protecting others from potential financial harm. By following these steps, you can anonymously play a part in combating fraudulent activities.
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Online fraud reporting systems
If you wish to report insurance fraud anonymously, there are several online fraud reporting systems you can use. Most states have fraud bureaus that allow you to report fraud online. Here are some examples of online fraud reporting systems:
- National Association of Insurance Commissioners Online Fraud Reporting System: This system allows you to report insurance fraud directly to your state fraud bureau. You can find the relevant bureau by visiting the National Association of Insurance Commissioners website and clicking on your state.
- NICB Online Reporting: The National Insurance Crime Bureau (NICB) investigates crimes related to various types of insurance, including auto, home, liability, and workers' compensation. You can report scams to the NICB online by providing details such as dates, names, phone numbers, emails, and URLs of suspected individuals or organizations.
- State-Specific Systems: Some states have their own online fraud reporting forms. For example, the Texas Department of Insurance (TDI) has an online fraud report form for individuals working in the insurance industry or special investigative units to report internal fraud related to TDI staff or operations. Similarly, the North Carolina Department of Insurance (NC DOI) website mentions that state government websites value user privacy and use HTTPS certificates to ensure secure connections.
- Program-Specific Hotlines and Websites: Depending on the specific insurance program involved in the fraud, there may be dedicated hotlines and websites for reporting scams. For example, Medicare, Medicaid, the National Flood Insurance Program, the Federal Crop Insurance Program, TRICARE, and the Affordable Care Act all have their own contact information and online reporting options.
When using these online fraud reporting systems, it is important to provide as much detail as possible about the suspected scam, including dates, names, contact information, and any other relevant information that can aid in the investigation.
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Frequently asked questions
You can report insurance fraud anonymously by calling the National Insurance Crime Bureau (NICB) at 1-800-835-6422 or reporting it online.
Examples of insurance fraud include filing a false or padded insurance claim, selling insurance without a license, or selling fake policies.
When reporting insurance fraud, it is important to provide as much detail as possible, including dates, names, phone numbers, emails, and URLs of suspected individuals and organizations.
Yes, you can report insurance fraud to the police or law enforcement agency in your jurisdiction.
Once a report of insurance fraud is made, the relevant authorities will investigate the matter and take appropriate action. This may include criminal charges and prosecution if fraud is substantiated.
