Report Fraud
Report

Report Fraud

If you suspect that someone is committing or has committed any form of fraud or abuse, please fill out the form below. Please provide as much information as possible. You may remain anonymous. However, if you choose not to provide your contact information, it may prevent us from fully investigating your complaint if questions arise during the review process.

I am a:
Member
Provider
Vendor

I suspect:
a member is committing potential fraud.
a provider is committing potential fraud.
a vendor is committing potential fraud.
Other:

Description of concern:
Please provide as many details as possible to assist us in investigating your concern. If available, include the following:

  • Start and end dates of the activity you are reporting
  • How the issue was discovered
  • Names, birth dates, ID numbers, or other contact and location information of involved parties
  Have you reported the concern to another individual or agency?
No    Yes
If yes, please enter the date(s), and name(s) of the individual(s) or agency:

You may report anonymously. If you are willing to be contacted for questions or would like to be updated on the outcome of the investigation, please include name and how you would prefer to be contacted(phone, email, or mailing address).


Are you willing to be contacted for additional information:
Yes  No
Would you like to be contacted regarding the outcome of the investigation:
 Yes  No
iCare enforces a strict no-tolerance policy for intimidation, retaliation, or retribution against any reporter who in good faith reports suspected Fraud, Waste, or Abuse or suspected compliance concerns. Reporters are protected from retaliation for False Claims Act complaints, as well as any other applicable anti-retaliation protections.
Modified: 5/11/2017
 

  • H2237_IC1453 Approved
 
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  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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