Report Fraud, Waste or Abuse Form

Report Fraud, Waste or Abuse
Contact Information (You May Remain Anonymous)
EmailPhone
What is your email address?
What is your phone number?
Please enter a valid phone number.
When is the best time to reach you?

Hour Minutes

AM/PM Option
MemberPharmacyMedical Provider/FacilityMedical Equipment and/or Supplier ProviderFinancial (Improper Use of GHC-SCW Financial Resources)Employer GroupOther

Drug Seeking Behavior or Prescription Fraud (When a patient who may or may not have a legitimate ailment goes from doctor to doctor and/or using their prescriptions for illegitimate purposes.)Eligibility Fraud (Providing false or misleading information on or omitting information from an application for medical benefits.)Identity Fraud Committed by or Against a Member (Sharing or stealing a medical ID. Theft of personal information by an individual to obtain medical care.)Other

False portrayal of an employer group to secure healthcare coverage.Enrolling individuals who are not eligible for healthcare coverage.Changing dates of hire or termination to expand dates of healthcare coverage.Other

Who Else Was Involved

Please provide a description of how they were involved, their name, and contact information if you know it.
Role in Issue
If known, what is their name?
If known, what is their phone number?
Please enter a valid phone number.
If known, what is their email address?
Please describe how this individual has knowledge of the suspected fraud, waste or abuse.
YesNo
Role in Issue
If known, what is their name?
If known, what is their phone number?
Please enter a valid phone number.
If known, what is their email address?
Please describe how this individual has knowledge of the suspected fraud, waste or abuse.

Review & Submit

Thank you for taking the time to report the suspected fraud, waste, and abuse. Please click the "Review" button to review your responses, or press “Submit” to send your report. Upon clicking submit, you will receive a case number. If you have questions or additonal information regarding this report, please contact fwa@ghcscw.com with your case number.If you have any attachments that you'd like to include, please use the file upload on this page.
Review & Submit

Thank you for taking the time to report the suspected fraud, waste, and abuse. If you would like to review your answers prior to submission please press the Back button, or press Submit to send your report. Upon clicking Submit, you will receive a case number. If you have questions or additonal information regarding this report, please contact fwa@ghcscw.com with your case number.

If you have any attachments that you'd like to include, please use the file upload on this page.
File Upload

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Report Fraud, Waste or Abuse