Report Fraud

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You may also call 1-877-926-9743.

Required field

Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Name has a maximum of 50 characters. Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Name has a maximum of 50 characters. Please enter last name. Please enter a valid email address. Please Enter valid Phone number. Please choose yes or no. Please enter the name of provider. Business name is required. Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Name has a maximum of 50 characters. Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Name has a maximum of 50 characters. Please enter last name. Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Name has a maximum of 50 characters. Please enter the Claimant Name Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Name has a maximum of 50 characters. Please enter the Claimant Name Medical Provider Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Claimant Name has a maximum of 50 characters. Please enter last name. Medical Provider Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Claimant Name has a maximum of 50 characters. Claim Number must only contain digits. Please enter why you suspect fraud is being committed. Please limit your answer to 1500 characters. Please limit your answer to 1500 characters. Please note the location (establishment and city).

Witness Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Witness Name has a maximum of 50 characters.

Please enter last name. Witness Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Witness Name has a maximum of 50 characters.

Witness Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Witness Name has a maximum of 50 characters.

Please enter last name. Witness Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Witness Name has a maximum of 50 characters.

Witness Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Witness Name has a maximum of 50 characters.

Please enter last name. Witness Name can only contain letters, periods, hyphens, ampersands, and single quotes.
Witness Name has a maximum of 50 characters. Please limit your answer to 1500 characters.