Medicaid Fraud Allegation Online Form
After your allegation is received, Xincon will evaluate it and take appropriate action. If you submit your name and contact information on the allegation, you will receive an acknowledgement from Xincon.Unless you have chosen to file your allegation anonymously, you may be contacted to verify details of the complaint or to provide additional information.
Your Contact Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Provider ID (if applicable):
Recipient CIN (if applicable):
Case Number (if applicable):
Nature of Allegation:
Please Select
Billing issue
Internal Affairs/OWIG
Other
Payment from recipient
Provider-Rx Fraud
Quality of Care issue
Recipient Eligibility
Recipient Misuse other than RX
Recipient Misuse RC Fraud
Service not rendered
Unlicensed Provider
Unncecessary Services
Allegation:
*
Select the Allegation Type
*
Provider Allegation
Client Allegation
Submit
Should be Empty: