Report Suspected Fraud and Abuse

Please call our fraud hotline at 1-833-663-8714 or complete the following form if you suspect an incident of fraud or abuse has occurred.

Who do you suspect is committing fraud?

Prefix:

Name:* The value is required. Invalid format.
Suffix:

Type of Physician: (If Applicable)
Address:* The value is required. Invalid format.
City:* The value is required. Invalid format.
State:* The value is required. Invalid format.
Zip Code:* The value is required. Invalid format.
Phone Number: Invalid format.

What fraudulent activity occurred? (Please describe in as much detail as possible.)*

The value is required.
Contract Number: (If the fraud involves services provided to you.) Invalid format. You can't enter more then 12 characters

Any additional comments?

May we contact you? (If additional information is necessary.)

Name: Invalid format.
Daytime Phone Number: Invalid format.
E-mail Address: Invalid format.

* Indicates Required Fields