Report Fraud and Abuse

Report

To report fraud or abuse, please fill out the form below. All information received is confidential. You may remain anonymous if you choose.

Please correct the following errors:

* Suspect Name

Suspect Address

* Suspect City

* Suspect State

Suspect zip code

Suspect Phone

* Date of incident

* Is the incident related to Medicare Part D coverage?

* Is the incident related to coverage purchased through the Federal Health Insurance Marketplace (Exchange)?

Is the incident related to medical, dental, or vision coverage?

* Details of complaint

Do you want to tell us information about you?

Yes I want to stay anonymous

Name

Address

City

State

Zip code

Home Phone

Work Phone

Email Address