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 Information
Provider/Recipient Name:
Provider/Recipient No: Provider Tax ID:
Recipient's Health Plan No:
National Provider Number (NPI):
Street:
City: State: Zip:
Contact:
Phone:  
When did you discover the issue you are reporting?  
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:  
Street:
City: State: Zip:

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.

Article I, section 24(a) of the Florida Constitution establishes a right of access to any public record made or received in connection with the official business of the Office of Inspector General, except with respect to those records exempted or specifically made confidential by Florida law. Under Florida’s broad public records laws, written, digital, audio-recorded, photographic, videographic, or stored information provided to the Office of Inspector General is, or will eventually be, available pursuant to a public records request unless a qualifying exemption to the public records laws exists that protects such information in perpetuity, such as is the case with the confidentiality of a qualifying Whistle-blower’s identity.

If you do not want your identifying information (such as your name, email address, physical address, and contact information) released in response to a public-records request, please do not send electronic mail to this entity. Instead, contact this office by phone at 850-412-3990 or view the AHCA Call Center webpage.

For more information, please read AHCA's privacy policy.