Report Fraud

Using the form below - Please enter the information about the person you suspect is committing Medical Assistance fraud.

Report Medical Assistance Fraud

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First Name: *

Last Name: *




Zip Code:


Briefly explain how you know they are committing fraud: *

When Did Alleged Fraud Start?

If they are working, please provide as many details as you can about their employer:

Employer Name:

Employer Address:

Employer City:

Employer State:

Zip Code:

Employer Phone:

What is your name, address, telephone number, and email address?

Your First Name:

Your Last Name:

Your Address:

Your City:

Your State:

Your Zip Code:

Your Phone Number:

Your Email Address:

Is this an emergency?



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