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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
Select
Alabama
Alaska
Arizona
Arkansas
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Panama Canal Zone
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
Select
Alabama
Alaska
Arizona
Arkansas
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Panama Canal Zone
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Your Telephone
ext
Your Email Address
Clear form
Submit