Before You Submit a Complaint

HHS-OIG�s Hotline reviews and investigates thousands of complaints each year. Before you begin, make sure you understand the type of complaints we address.

Complaints we investigate include:

• Complaints from HHS employees, grantees or contractors about fraud, waste, abuse or mismanagement in HHS programs (whistleblower complaints),
• Crime, gross misconduct, or conflicts of interest involving HHS employees, grantees or contractors,
• Fraud, waste, or abuse relating to HHS grants or contracts,�
• False or fraudulent claims submitted to Medicare or Medicaid,
• Kickbacks or inducements for referrals by Medicare or Medicaid providers,
• Medical identity theft involving Medicare and/or Medicaid beneficiaries,
• Failure of a hospital to evaluate and stabilize an emergency patient,
• Abuse or neglect in nursing homes and other long-term-care facilities
• Human Trafficking by HHS employees, contractors or grantees to include procuring a commercial sex act

Complaints not addressed through the OIG Hotline include:

Issues about Medicare policy, coverage, billing claims or appeals

Lost or stolen Medicare card

Allegations by HHS employees of discrimination on the basis of race, gender, ethnicity, religion or sexual preference

Allegations by employees or applicants concerning prohibited personnel practices; or Hatch Act violations

Appeals of administrative decisions made by HHS agencies, grantees or contractors, including Medicare payment decisions and contract or grant awards

Consult the guidelines for the particular program

Appeals of judicial decisions by federal or state courts involving HHS programs

Please�contact the court that issued the decision

Complaints of failure to safeguard medical information, i.e. HIPAA violations

Customer service complaints involving HHS employees, grantees or contractors

Management of the relevant agency

Fraud relating to Social Security

Allegations of identity theft unrelated to HHS programs

SNAP/Food Stamp Fraud

What You Need for Your Complaint

Our investigations are most successful when you provide as much information as possible about the allegation and those involved. The more you tell us, the better chance we have of determining whether an investigation can be pursued. Before you begin, make sure you have the following information available:

• Name and contact information of the individual or business related to your complaint. This includes, if available, addresses, telephone numbers, e-mail addresses, etc.
• Narrative explaining the nature, scope, time frame and how you came to learn about the activity in question.
• The name and contact information of any individual who can help corroborate the information you are reporting.
• Supporting evidence in electronic format that can be uploaded with your report. This may include e-mail communications, documents, billing records or photographs.

Important

If your purpose in filing a complaint is to gain some type of relief—such as obtaining a refund from a Medicare-participating provider or qualifying for benefits from an HHS-funded program—we strongly advise that you pursue other administrative or judicial remedies. OIG rarely intervenes in personal or civil grievances.

Privacy Safeguards

OIG Hotline Operations complaints are official records covered by the Privacy Act. OIG Hotline Operations complaint referrals are provided to non-OIG offices for review and response on an official-need-to-know basis only, and must not be released to the subjects of complaints. Although additional information may be received during the course of a complaint, such items are part of the OIG Hotline file and its release is subject to OIG approval.

What to Expect After Submitting Your Complaint

An OIG analyst will review your complaint for relevance and completeness. Not all complaints result in an investigation.

If you have identified yourself, a reviewing official may contact you for further information. However, if you are not contacted it does not mean your complaint is not being investigated.

Important

The Hotline will not be able to confirm receipt of your complaint or respond to any inquiries about action taken on your complaint. We understand the natural inclination to follow up on a report but OIG does not provide the status of complaints.

You have the option, however, of requesting records through the OIG�Freedom of Information Act officer. Remember to phrase your request in terms of a search for records pertinent to your complaint, not status. You should wait at least six months before filing such a request.

Appealing an OIG Hotline Operations Complaint Decision

There are no appeal rights to a decision by OIG Hotline Operations as to the actions taken on a particular complaint. OIG Hotline Operations is not a statutory entity, court, or other administrative body. The IG Act gives the Inspector General sole discretion regarding the processing and investigation of hotline complaints.

What to Expect After Submitting Your Complaint

An OIG analyst will review your complaint for relevance and completeness. Not all complaints result in an investigation. If you have identified yourself, a reviewing official may contact you for further information.

IMPORTANT

The Hotline will not be able to confirm receipt of your complaint or respond to any inquiries about action taken on your complaint. We understand the natural inclination to follow up on a report but OIG does not provide the status of complaints. You have the option, however, of requesting records through the OIG�Freedom of Information Act officer. Remember to phrase your request in terms of a search for records pertinent to your complaint, not status. You should wait at least six months before filing such a request.

• Complaints from HHS employees, grantees or contractors about fraud, waste, abuse or mismanagement in HHS programs (whistleblower complaints),
• Crime, gross misconduct, or conflicts of interest involving HHS employees, grantees or contractors,
• Fraud, waste, or abuse relating to HHS grants or contracts,�
• False or fraudulent claims submitted to Medicare or Medicaid,
• Kickbacks or inducements for referrals by Medicare or Medicaid providers,
• Medical identity theft involving Medicare and/or Medicaid beneficiaries,
• Failure of a hospital to evaluate and stabilize an emergency patient,
• Abuse or neglect in nursing homes and other long-term-care facilities.
• Human Trafficking by HHS employees, contractors or grantees to include procuring a commercial sex act

You may provide your complaint anonymously. However, the lack of contact information prevents a comprehensive review of the complaint and will prevent further communication between you and HHS-OIG. Read more about privacy safeguards.