CHRF - Report Fraud by a Child Care Benefit Provider

Report Fraud by a Child Care Benefit Provider

Once the report is sent, the coordinator has no further information about an investigation.

Confidentiality law may prevent the department from sharing any further information unless specifically required.

Report suspected Medicaid provider fraud, waste, or abuse by using The Medicaid Provider Fraud Reporting Form.

Date of Report

Description of what happened (Required)

Please provide as much detail as possible. Maximum 300 words.

Word count: 0

The Provider You Are Reporting

Important: You may enter Company Name or Person's Name or Both, but at least one is required.

Company Name

Note: If you enter a person's name, the first and last name are required.

First Name

Middle Name

Last Name

Suffix

Address 1

Address 2

City

State

Zip Code

Email Address

Phone Number

Enter 10 numbers

This information is optional, however if you start entering this data then the first name and last name will be required!