To report suspected fraud to UnitedHealthcare, call the member fraud hotline at 1-844-359-7736, file a report through the company’s EthicsPoint portal at secure.ethicspoint.com, or use the customer service number printed on the back of your insurance card. Medicare members should call 1-800-MEDICARE (1-800-633-4227). You can report anonymously, and you don’t have to be a UnitedHealthcare member to file.1UnitedHealthcare. Health Care Fraud and Abuse2UnitedHealthcare. Fraud Frequently Asked Questions
Where To Send the Report
UnitedHealthcare routes fraud tips through a third-party platform operated by NAVEX, reached through EthicsPoint. The company says the arrangement is meant to protect reporter information and keep reports handled without bias.1UnitedHealthcare. Health Care Fraud and Abuse
- Online at secure.ethicspoint.com. The same site lets you follow up on a prior report using the PIN and password assigned when you filed.1UnitedHealthcare. Health Care Fraud and Abuse
- By phone for most members at 1-844-359-7736.2UnitedHealthcare. Fraud Frequently Asked Questions
- By phone for Medicare members at 1-800-MEDICARE (1-800-633-4227).1UnitedHealthcare. Health Care Fraud and Abuse
- Through the customer service number on the back of your insurance card. UnitedHealthcare suggests starting there if the issue might turn out to be a billing error rather than fraud.1UnitedHealthcare. Health Care Fraud and Abuse
If your coverage is administered by UMR, a UnitedHealthcare company that handles self-funded employer plans, it has a separate hotline at 800-356-5803 and online reporting forms in English and Spanish.3UMR. Report Fraud
For concerns involving Optum, customers and partners can email reportfwa@optum.com. Behavioral health fraud concerns go to optum.pni.tips@optum.com. The broader UnitedHealth Group Compliance and Ethics HelpCenter runs around the clock at 800-455-4521 and online at uhghelpcenter.ethicspoint.com, and a separate Vendor Fraud Hotline takes confidential reports about suspected vendor misconduct at 877-401-9430.4UnitedHealth Group. Code of Conduct5UnitedHealth Group. Supplier Contact Information
Can You Report Anonymously
Yes. Both the online portal and the phone hotline accept anonymous reports. UnitedHealthcare says that even if you give your name, the provider being investigated will not be told who filed. Anyone can file, member or not.2UnitedHealthcare. Fraud Frequently Asked Questions UnitedHealth Group’s code of conduct also prohibits retaliation against anyone who makes a good-faith report of suspected fraud or misconduct.4UnitedHealth Group. Code of Conduct
What Happens After You File
Online reports enter the NAVEX EthicsPoint system, which runs around the clock and supports multiple languages. You get a unique PIN and password tied to your case. Those credentials let you log back in, read messages from investigators, and send additional information without revealing who you are.6NAVEX. EthicsPoint Professional
On the receiving end, the report is routed to compliance, ethics, or legal personnel. They may post follow-up questions back through the platform. If an anonymous reporter never returns to check, the case can be closed for lack of information, so logging back in matters. Investigators may also ask you to voluntarily switch from anonymous to named status for a fuller inquiry; that is optional.7NAVEX. Improving the Investigation of Anonymously Reported Concerns
What To Have Ready Before You Call
A useful tip identifies who, what, and when. Have the name of the provider or business, the dates of service in question, a description of what happened, and any paperwork that documents it: Explanation of Benefits statements, bills, receipts, letters, emails, or appointment records. If there are other people who saw what happened, note their names.8HHS Office of Inspector General. Before You Submit a Complaint
Catching Fraud on Your Explanation of Benefits
The Explanation of Benefits is the practical starting point for most member-reported fraud. After a claim is processed, UnitedHealthcare sends an EOB describing what services were billed, what the plan paid, and what you owe. Compare it against your own records so the listed services, dates, and provider names match what you actually received.9UnitedHealthcare. Explanation of Benefits
Red flags include charges for services you never got, billing from providers you don’t recognize, dates that don’t match your appointments, duplicate charges, and equipment or supplies showing up as billed when you were told they were free.10UnitedHealthcare. Protecting Against Fraud A good first step is calling the provider to ask for an itemized bill. If the explanation isn’t satisfactory, or if the pattern looks intentional, report it through the UnitedHealthcare fraud channels or to a federal agency.9UnitedHealthcare. Explanation of Benefits
The schemes UnitedHealthcare says it sees most often fit familiar patterns: billing for office visits, telehealth, or supplies never provided; upcoding to a more expensive service than what was performed; durable medical equipment companies obtaining prescriptions for unnecessary braces, often after unsolicited calls asking for insurance ID numbers; “free” DNA or genetic testing offered as a way to collect insurance information; and scammers posing as Medicare or insurance representatives by phone or in person. Using someone else’s Medicare card to get care, supplies, or prescriptions is identity theft and also reportable.10UnitedHealthcare. Protecting Against Fraud11UnitedHealthcare. Health Care Fraud and Abuse Schemes12UnitedHealthcare. Medicare Healthcare Fraud
When To Report to a Federal Agency Instead
Fraud involving UnitedHealthcare claims, especially Medicare claims, can also go directly to federal authorities with independent investigative power. You can report to both UnitedHealthcare and a federal agency; they are not alternatives.
HHS Office of Inspector General
The HHS Office of Inspector General is the primary federal watchdog for fraud in Medicare, Medicaid, and other HHS programs. Tips go to tips.oig.hhs.gov or 1-800-HHS-TIPS (1-800-447-8477). The OIG asks for the name and contact information of the person or business involved, a description of what happened and when, names of potential witnesses, and any supporting documents such as billing records or emails.13HHS Office of Inspector General. Report Fraud8HHS Office of Inspector General. Before You Submit a Complaint
Complaints are protected under the Privacy Act and shared outside the office only on a need-to-know basis. The OIG does not confirm receipt or provide status updates, and because of the volume of tips, not every submission leads to an investigation.8HHS Office of Inspector General. Before You Submit a Complaint
I-MEDIC for Medicare Advantage and Part D
For fraud involving Medicare Advantage plans or Medicare Part D prescription drug plans specifically, contact the Investigations Medicare Drug Integrity Contractor, known as I-MEDIC, at 1-877-7SAFERX (1-877-772-3379). I-MEDIC handles complaint intake, investigates, and refers findings to CMS and law enforcement.14Medicare.gov. Reporting Medicare Fraud and Abuse15Qlarant. I-MEDIC Current Contracts
Senior Medicare Patrol and State Insurance Departments
The Senior Medicare Patrol program, federally funded, helps Medicare beneficiaries identify and report fraud. The national line is 1-877-808-2468, and local offices can be found through smpresource.org. SMPs can help review suspicious charges and refer cases to the OIG, CMS, or state authorities.16CMS. Center for Program Integrity Reporting Fraud17Senior Medicare Patrol. Report Fraud State insurance departments also take fraud reports; the National Association of Insurance Commissioners runs an Online Fraud Reporting System at ofrs.naic.org that routes complaints to the right state agency.18NAIC. Consumer Information
If You Have Inside Knowledge of a Larger Fraud
Hotlines are the right path for most members. If you have detailed knowledge of fraud against federal health care programs, usually as an employee or contractor, there is a separate route with legal protections and potential financial recovery. Under the federal False Claims Act’s qui tam provisions, a private person (the “relator”) files a complaint under seal in federal court and provides evidence to the Department of Justice, which then decides whether to take over the case.19HHS Office of Inspector General. Fraud and Abuse Laws
If the government recovers money, the whistleblower can receive between 15% and 30% of the proceeds, depending on how involved the government becomes.20JAMA Health Forum. False Claims Act and Qui Tam Provisions The law also protects relators from employer retaliation. Workers fired, demoted, or harassed for pursuing a False Claims Act case may be entitled to reinstatement, double back pay, and litigation costs.21National Whistleblower Center. False Claims Act Qui Tam FAQ
Thirty-three states and territories have their own false claims laws with qui tam provisions, and 41 jurisdictions have some form of false claims statute. Coverage varies: Texas and Oklahoma restrict private qui tam actions to Medicaid cases, while California and Illinois extend their laws to fraud against private insurers.22Taxpayers Against Fraud. State False Claims Acts
One caveat worth knowing before you commit to a qui tam case: the mechanism is under legal challenge. In September 2024, a federal district judge in Florida ruled in United States ex rel. Zafirov v. Florida Medical Associates that qui tam provisions are unconstitutional because they vest executive power in private individuals not appointed by the president. The case was appealed to the Eleventh Circuit, which heard oral arguments in December 2025.23Georgetown Law Litigation Tracker. United States ex rel. Zafirov v. Florida Medical Associates Justice Clarence Thomas called the mechanism a “constitutional Twilight Zone” in a 2023 dissent, and Justice Brett Kavanaugh suggested in a February 2025 concurrence that the Supreme Court should address the question.20JAMA Health Forum. False Claims Act and Qui Tam Provisions For now, qui tam remains available, and if you think you have that kind of case, consult a whistleblower attorney before filing anything.