Report Medicaid or Medicare Fraud Online

My Name:

My Personal Email (not employer's):

Best Phone to Reach Me:

My State:

I am Reporting this Healthcare Provider:

Are or Were You an Employee?

Date(s) of Fraudulent Conduct:

Description of Fraud (100 word maximum):

So we know you're a person:

How many sides does a square have?

We promise to use this only to contact you about your report