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Attorney General > Criminal Justice > Medicaid Fraud > Report Medicaid Fraud Report Medicaid Fraud

This complaint form is to report fraud by Medicaid providers only (i.e. Transportation Companies, Durable Medical Equipment Companies, Hospitals, Doctors, Dentists, Pharmaceuticals Companies, etc.). If you would like to report Medicaid recipient fraud, please contact the Family & Social Services Administration at 800.446.1993.

Please fill out the following form as completely and accurately as possible. The more detailed information you provide, the more efficient and effective our staff can be in their investigation of the incident reported.

Required Field Required Field

Your Contact information

Are you reporting alleged Medicaid fraud against a current or former employer?

Name:

Address:

City:

Zip:

Phone number:

E-mail address:

Information about the Medicaid provider fraud:

Required Field Medicaid Provider Name:

Medicaid Provider St. Address:

Required FieldMedicaid Provider City:

Medicaid Provider Zip:

Medicaid Provider's Phone Number:

Approximate date or timeframe of alleged fraud:

Required Field Description of alleged Medicaid provider fraud and the estimated amount of money involved (if known). Please be as thorough as possible.

Required Field How did you learn of this fraud:

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