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Medicaid Fraud and Abuse Complaint Form
Office of the Inspector General

The office of the Inspector General at the Agency for Health Care Administration accepts complaints alleging wrong-doing of an Agency employee and suspected fraud and abuse in the Florida Medicaid system. If you suspect Medicaid fraud, contact the fraud and abuse hotline (1-888-419-3456).


Provider/Recipient Name
Provider/Recipient Number:
Provider Tax Id:
Recipient's Health Plan Number:
National Provider Number(NPI):
Street:
City:
State:
Zip:
Contact:
Phone:
Date of Complaint: (Ex:mm/dd/yyyy)
 
Describe the suspected fraudulent or abusive activities (including background, persons involved, events, dates and locations). Be sure to include the who, what, when, where, why and how of the situation:



Complainant Information

Name of Complainant:
Email:
Phone:
Address:

Every complaint is reviewed by the Office of the Inspector General. It is either investigated or sent to the appropriate office for handling. You will receive a written response from our office. The more specific information that you provide to us, the better we are able to assist you.

  

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. For more information, please read AHCA's privacy policy.

Reporting Medicaid Fraud