Alabama Medicaid Fraud, Waste and Abuse Reporting Form

Individuals who report allegations are not required to provide their identity to Medicaid. However, persons who report allegations are encouraged to identify themselves to help Medicaid evaluate and investigate the complaints.

What You Need for Your Complaint

Medicaid investigations are most successful when you provide as much information as possible about the allegation and those involved. The more you tell us, the better chance we have of determining whether an investigation can be pursued. Before you begin, make sure you have the following information available:

Name and contact information of the individual or business related to your complaint. This includes, if available, addresses, telephone numbers, email addresses, etc.
Narrative explaining the nature, scope, timeframe, and how you came to learn about the activity in question.
The name and contact information of any individual who can help corroborate the information you are reporting.
Supporting evidence in electronic format that can be uploaded with your report. This may include email communications, documents, billing records or photographs.

Your selection of one of the filing options below implies you have reviewed the information and understand the choice you are making.

Who is the allegation about? (required)

Recipient/Beneficiary

Provider

Vendor/Contractor

Other Entity

Contact information of the individual/business the complaint is against:

Name:

Street address:

City/State/Zip code:

Telephone number:

Email address:

+ Add another contact

Dates of Allegation:

Location of Allegation: