Amerigroup Real Solutions in Healthcare | Report Waste, Fraud & Abuse

This form is to tell us of suspected waste, fraud or abuse of services paid for by AMERIGROUP Community Care. 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:

Street Address:

Provider or Practice Name:

Suite/Office Number:

City:

State:

ZIP:

Telephone:

Ext:

Please enter any information about the suspected member or provider:

Please tell us about the activity that may be waste, fraud or abuse. Some examples are:
- Billing for services you did not get
- Someone using your identity to receive medical services.
give details that tell us 'who, what, when, where, why and how.'

Other Information: We may need to talk with you about the information you gave us. Please give us your name, phone number, address and/or email address below. We may call you for more information. If you give us your contact information, your identity will be protected to the extent allowed. Thank you for helping AMERIGROUP Community Care‘s efforts to find waste, fraud and abuse.