Report Suspected Fraud or Abuse

Please complete the following form if you believe an incident of fraud or abuse has occurred. This form will initiate a referral to the Special Investigation Unit at Health First Health Plans for further investigation.

To protect the confidentiality of all parties involved, you will not be notified of the results of the investigation. Please fill out all relevant sections and click the SEND button.

Who do you suspect may be committing fraud?

Please provide the name and contact information of the individual or company you suspect may have committed fraud or abuse.

What type of healthcare fraud do you suspect is being committed?

Please identify if the activity is related to medical or pharmaceutical benefits:

Where and when did the suspicious activity occur?

Please provide dates and/or time frames of where and when this activity occurred:

Please describe the suspicious activity in detail. Be sure to include the names of all applicable parties involved and why you believe a fraudulent or abusive act has occurred. The more information provided the more thorough an investigation the SIU will be able to achieve.

If you would like to send supporting documentation, please send it to:

  • Mail:    
    Health First Health Plans, Inc.
    Attn: Special Investigations Unit
    6450 US Highway 1
    Rockledge, FL 32955

Unless you chose to remain anonymous, please provide us your name and contact information so we may contact you with any additional questions during our investigation. Your personal information will remain confidential and will only be disclosed when required by law.

Name
Phone
E-mail
Address

 


Y0089_MP3802 CMS Approved 03242014
Last Updated: 10/01/2013