Waste, Fraud, and Abuse

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Report Waste, Fraud, and Abuse

This form is to tell us of suspected waste, fraud or abuse of services paid for by Amerigroup.
Please fill in as much of the information as you can below and click the submit button.

Information on the Suspected Member or Provider:

First Name

Last Name

Middle Initial

Suffix

Provider or Practice Name

Street Address

Suite

City

State

Zip

Telephone

ext

About the suspected member or provider:

Enter any information about the suspected member or provider:

Tell us about the activity that may be waste, fraud or abuse:

Give details that tell us who, what, when, where, why and how.
Some examples are:

Billing for services you did not receive
Someone using your identity to receive medical services.

How can we contact you?

Please provide your contact information so we can contact you if we have questions. Your identity will be protected to the extent allowed. Thank you for helping Amerigroup's efforts to find waste, fraud and abuse.

Your First Name

Your Last Name

Your Middle Initial

Suffix:

Your Street Address

City

State

Zip

Your Telephone

ext

Your Email Address

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