Report Suspected Fraud or Abuse of the Program

The Office of Program Integrity (OPI) provides a way for individuals, plans, and providers to report all forms of abuse including, suspected fraud or abuse of the program. Everyone (members/beneficiaries, caregivers, health plans, and the public) can report suspected fraud or abuse of the program with this online form.

Note: If you need to report abuse of a member, you will need to follow the steps outlined in the Report Abuse of a Member Form [Word, 49KB].

Please Enter Your Contact Information

NOTE: You may choose to remain anonymous and still submit a referral. AHCCCS does not receive any information about you, except for what you are willing to provide in the fields listed below.

Your First Name:

Your Last Name:

Your Title (if applicable):

Your Company's Name (if applicable):

Your Address:

City:
State:
ZIP Code: (xxxxx-xxxx, last four optional)

Your E-Mail Address:

Your Phone Number:

Return Call Requested:
YesNo Please Enter Suspected Fraud Information

* required fields

Name of Provider or Company Allegedly Involved (if applicable):

Provider Address (if known):

AHCCCS Provider ID (if known):

Provider Phone Number (if known):

Name of AHCCCS Recipient/Member Allegedly Involved (if applicable):

Member Date of Birth (if known):
(dd/mm/yyyy)
Member Address (if known):

Case Number (if known):

Member AHCCCS ID Number (if known):

Member Phone Number (if known):

Estimated Dollar Loss to AHCCCS (if known):

*Please Describe Suspected Fraud, Waste, or Abuse: