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NC Medicaid »   Meetings & Notices »   Report Fraud, Waste or Abuse »   Medicaid Fraud and Abuse Confidential Complaint Form

Medicaid Fraud and Abuse Confidential Complaint

You are encouraged to report matters involving Medicaid fraud and program abuse. If you want to report fraud or program abuse, you may remain anonymous. All complaints of misconduct are kept confidential and are protected from disclosure according to the North Carolina State Administrative Procedure Act, Section 10A NCAC 23H .0103 (formerly 10A NCAC 21A.0403) or Section 10A NCAC 22F.0106. The Division of Health Benefits (DHB) Office of Compliance and Program Integrity will not reveal the identity of the complainant to any person, except as required by law.

After completion of form, you must press the SUBMIT button. You will receive an acknowledgement email to print for your record.

Indicates required field

If you wish to remain anonymous, you do not have to provide your personal information. Failure to provide detailed information can affect Program Integrity’s ability to review the complaint to its fullest extent.

Contact Information


Name
Address

Beneficiary


Beneficiary Name
Address

Please provide as much detail as possible including names of individuals involved, employer name, self-employment business name, dates of alleged occurrence and details of the complaint. Failure to provide detailed information can affect the ability to review the complaint to its fullest extent.

Medicaid beneficiary failed to report all income when applying for Medicaid

Employer's Address

Medicaid beneficiary failed to report all household members

Medicaid failed to report assets/resources or property (examples cash on hand, bank accounts, life insurance, property out of country of state, etc.)

Medicaid beneficiary failed to report other insurance when applying for medical assistance

If a copy of the insurance card is available, please fax front and back to (919) 800-3186.

Non-Beneficiary uses a beneficiary's Medicaid card

Dates of alleged occurence
more items

Medicaid beneficiary is no longer living in NC but has NC Medicaid benefits

New address

Enter month and year (i.e. 06/2021)

Other allegations not listed above

Please provide as much detail as possible including names of individuals involved, dates of alleged occurrence and details of the complaint. Failure to provide detailed information can affect the ability to review the complaint to its fullest extent. 


Provider


Provider Address

Please provide as much detail as possible including names of individuals involved, employer name, self-employment business name, dates of alleged occurrence and details of the complaint. Failure to provide detailed information can affect the ability to review the complaint to its fullest extent.


Managed Care Organization

Please provide as much detail as possible including names of individuals involved, employer name, self-employment business name, dates of alleged occurrence and details of the complaint. Failure to provide detailed information can affect the ability to review the complaint to its fullest extent. 


If you have supporting documents you would like to have included in the investigation, fax or mail the documents to: 

 

DHB Office of Compliance and Program Integrity 
2501 Mail Service Center 
Raleigh, NC 27699-2501 

Phone: 919-527-7700
Fax: 919-831-1808

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Contact Information

NC Medicaid
Division of Health Benefits

2501 Mail Service Center
Raleigh, NC 27699-2501
 
NC Medicaid Contact Center
Phone: 888-245-0179
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays. 
 
Visit RelayNC for information about TTY services. 
 
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https://medicaid.ncdhhs.gov/Medicaid%20Fraud%20and%20Abuse%20Confidential%20Complaint