How to Check if Your Doctor Has Medicare Fraud Flags
A step-by-step guide to looking up any doctor's Medicare billing patterns, fraud risk scores, and exclusion status.
Quick Check: Look Up Your Doctor Now
Enter any provider's name or NPI number to see their Medicare billing data, fraud risk score, and peer comparisons.
Open Provider Lookup Tool →Why Should You Check Your Doctor's Medicare Record?
Medicare fraud costs taxpayers an estimated $60–100 billion annually. While most doctors are honest, fraudulent providers can put patients at risk in several ways:
- Unnecessary procedures — some fraudulent providers order tests or procedures you don't need to bill Medicare
- Phantom billing — you may be billed for services you never received, which can affect your Medicare benefits
- Quality of care — providers focused on maximizing billing may cut corners on actual patient care
- Excluded providers — some providers continue practicing even after being excluded from Medicare by the OIG
The good news: all Medicare billing data is public. You can check any provider in minutes.
Use the OpenMedicare Lookup Tool
Our free Provider Lookup Tool is the fastest way to check any doctor. Here's what you'll find:
- ✓Total Medicare payments — how much Medicare has paid this provider over 10 years
- ✓Service volume — how many services they billed and how many patients they saw
- ✓AI fraud risk score — our machine learning model compares their billing to 8,300+ confirmed fraudsters
- ✓Peer comparison — how their billing compares to others in the same specialty and state
- ✓Procedure breakdown — exactly which services they bill Medicare for
How to search: Go to /lookup and enter the provider's name, NPI number, or specialty. Results include all providers in our database of 1.7 million+ Medicare providers.
Check the OIG Exclusion List
The HHS Office of Inspector General maintains the List of Excluded Individuals/Entities (LEIE) — a database of providers who have been banned from participating in Medicare and Medicaid. If your doctor is on this list, Medicare will not pay for their services.
⚠️ Important: Some excluded providers continue to practice and bill patients directly. If your provider is on the LEIE, you should find a new provider immediately. Medicare will not cover any services from an excluded provider.
You can search the LEIE directly at exclusions.oig.hhs.gov. We also integrate LEIE data into our Fraud Watchlist for easier cross-referencing.
Understand What the Flags Mean
Not all flags mean fraud. Here's how to interpret what you find:
Billing patterns are normal for their specialty and location. No action needed.
Some billing anomalies detected. Could be legitimate (high-volume practice, unique specialty mix) or warrant closer attention. Review their procedure breakdown.
Billing patterns closely resemble confirmed Medicare fraudsters. This does NOT mean they are committing fraud — but their statistical profile matches those who have been convicted. Our Still Out There page profiles the highest-risk providers.
This provider has been formally excluded from Medicare/Medicaid by the OIG. They are banned from billing federal healthcare programs. If they are still seeing patients, this is a serious concern.
What to Do If Your Doctor IS Flagged
If you find that your doctor has a high fraud risk score or appears on the OIG exclusion list, here's what to do:
🔍 Don't Panic — Investigate First
A high fraud score means statistical resemblance to fraudsters, not a conviction. Look at the specific billing details. High-volume legitimate practices (e.g., large group practices, drug-administering oncologists) can score higher.
📋 Review Your Medicare Summary Notices
Check every service listed on your MSN. If you see charges for services you didn't receive, dates you didn't visit, or equipment you never got — that's a red flag.
📞 Report Suspected Fraud
Call the OIG hotline: 1-800-HHS-TIPS (1-800-447-8477). You can also file online at oig.hhs.gov. Under the False Claims Act, whistleblowers can receive 15–30% of recovered funds. See our complete reporting guide.
🏥 Consider Switching Providers
If your provider is OIG-excluded, switch immediately. For high-risk-score providers, use our provider directory to find alternatives in your area with clean billing records.
Other Ways to Research Your Doctor
Provider Directory
Browse all 1.7M+ Medicare providers with billing data and rankings.
Fraud Watchlist
500 providers flagged by AI for suspicious billing patterns.
Still Out There
Providers with the highest fraud probability scores still actively billing.
Compare Providers
Side-by-side comparison of any two providers' billing patterns.
Frequently Asked Questions
Is it legal to look up my doctor's Medicare billing?
Yes. All Medicare provider payment data is public information, released annually by CMS. OpenMedicare simply makes this data easier to search and understand.
Does a high fraud score mean my doctor is a criminal?
No. Our AI model identifies statistical patterns that resemble convicted fraudsters. Many legitimate high-volume providers may score higher. A flag is a signal to look more closely — not an accusation.
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number assigned to every healthcare provider. You can find your doctor's NPI on any Medicare billing statement or by searching our lookup tool.
How often is this data updated?
CMS releases new Medicare payment data annually, typically with a 1–2 year lag. Our database currently covers 2014–2023. AI fraud scores are recalculated with each data release.