Medicaid Fraud and Abuse Confidential Complaint Form

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, Sections 10A NCAC 21A.0403. DMA 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.

If you wish to remain anonymous, you do not have to provide your personal information.
If yes, complete the information below.
Provide a detailed description for each type of allegation checked and for "other" allegations. If appropriate, include date(s) of service, Medicaid recipient names(s), Medicaid ID numbers(s), and recipient date(s) of birth. Please describe the specific Medicaid service involved (such as chiropractic or physician services, PCS in-home aide services, physical therapy, diabetic supplies, community support services, etc.