If you suspect someone of fraud, please let us know by filling out this form.
Important Note: Please know that this form is not sent via secure e-mail! So please do not include any confidential, personal health information on this form. If you will need to share confidential information, please include your contact information so we can contact you directly for details. Thank you!
* indicates a required field
Person or Company You Suspect of Fraud
Customer This Affected
(Optional! You may remain anonymous.)