CMS's Processing of Complaints Received Through The 1-800-HHS-TIPS HOTLINE

摘要

The objective of this program is to assess the Centers for Medicare & Medicaid Services (CMS) processing of complaints received through the 1-800-HHS-TIPS hotline. Many Offices of Inspector General (OIG) operate hotlines to respond to citizen and employee allegations of fraud, waste, or abuse in Federal programs. The Department of Health & Human Services (HHS) OIG maintains such a hotline (1-800-HHS-TIPS), for individuals to provide information that may assist in combating fraud, waste, or abuse in HHS programs (e.g., Medicare, Medicaid, child support enforcement, and Head Start). Individuals may call the hotline or send their written concerns by email, postal mail, or fax. We obtained a copy of the hotline complaint data in CMS's information system as of March 2009. We identified 1,427 complaints that OIG forwarded to CMS in the first 6 months of 2008. From these, we selected a simple random sample of 120 complaints. We telephoned staff at each contractor assigned to the sampled complaints to inquire about what initial research the contractor performed to validate each complaint; how and when the contractor contacted the complainant; and what outcomes (e.g., recouping an overpayment from the provider) resulted from the contractor's actions on the complaint.