Fraud, waste and abuse

At ${plan_name_circle_R}, we take fraud, waste and abuse seriously. Protecting against fraud, waste and abuse is everyone’s responsibility.

What are fraud, waste and abuse?

Tell us about fraud, waste or abuse you suspect. You’ll want to fill in all fields with an asterisk (*).

*SUBJECT OF COMPLAINT

*Their Name

Their Address 1

Their Address 2

*Their City

*Their State

Their Zip Code 12345

Their Phone Number

*Tell Us Why

Tell us why you suspect this person, company or facility of wrongdoing. For example, what they did, when it happened and anything else you need us to know.

Your info (optional)

You don’t need to give us your name or contact info. But if you choose to, we’ll keep it private. You can also choose to give us just your contact info and not your name.

We’ll only review the info that you choose to report. You’ll want to give us as much info as you can. That way, we can understand what happened.

First Name

Last Name

Address 1

Address 2

City

State

Zip Code 12345

Phone Number 1234567890

EXT

EMAIL ADDRESS sample@example.com

PREFERRED CONTACT METHOD

PREFERRED CONTACT TIME

Organization Name

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Fraud, waste and abuse

What are fraud, waste and abuse?

Your info (optional)