Skip Navigation
Michigan Department of Community HealthMichigan.gov, Official Website for the State of Michigan
Michigan.gov Home
close print view


Office of Inspector General
MEDICAID FRAUD AND ABUSE ONLINE COMPLAINT FORM 

If you suspect that someone is, or has committed any form of Medicaid fraud or abuse and would like to file a complaint, please fill out the form below. When completing the form, fill out as much information as possible, including name and contact information for follow up. Contact information is not mandatory so you may remain anonymous if you choose. If you have any further questions/concerns, please call toll free 1-855-MI-FRAUD. 

  • You may be contacted regarding this complaint. 
  • Be sure to clear the internet browser cache so others using the workstation won't see that you visited this site. 
  • More information about  Medicaid Fraud and Abuse Reporting  
        
     

           

    Contact Name:                            

    Contact Phone Number:              

    Email Address:                            

    Health Plan Name (if known):     


      

    Individual Name (last, first):           

    Business Name:                             

    Address:                                         

    City, State:                                      

    Zip Code:                                                    

    Relationship to complainant:           


    If you suspect a provider, please provide the following information if known:

    Group Name/NPI #:   
     

    Individual NPI #:        

    NCPDP:                      

    If you suspect a beneficiary, please provide the following information if known:  

    Beneficiary ID #:     
     

    Case #:                     
     
    Health Plan Name:   


    BRIEF DESCRIPTION OF THE SUSPECTED FRAUD/ABUSE

    Date of Incident:   
                     Police Report Filed?:  No  Yes


    Nature of the Complaint 
     

    * Spam Block: (What's this?)
      
QR code

Michigan.gov Home
PoliciesMichigan NewsMichigan.gov Survey

Copyright © 2014 State of Michigan