Medicaid Fraud & Abuse
Incident Report/Case Referral

If your complaint involves fraud committed by a Medicaid provider or the abuse, neglect or exploitation of someone in a health care facility or a board and care facility please complete the form below.

We take our responsibility to protect patients within the Medicaid program and preserve its funds for the proper reimbursement of health care providers seriously.

In order to help us carry out our responsibilities, you may use this form to tell us about Medicaid fraud or abuse.  Please give us as much information as possible.  This will help us properly review the matter.  Incomplete information may prevent a thorough review of the matter.

We may need to contact you to obtain additional information about this report.  Even if you prefer to have your identity remain confidential, we would still like to have your contact information in case we need additional information.  We will make every effort to assure that your identity remains confidential and will release it only if required by law or judicial process.

Once we receive your incident report, we may:

  • Contact you if we need any additional information;
  • Determine there is no violation based on the information provided;
  • Open an investigation to gather more information;
  • File a case and seek an appropriate remedy;
  • Close the matter if no violation is found.

If you provide your contact information, we will tell you about the outcome after our investigation or any case is concluded.

You may also call the Medicaid Fraud reporting hotline at (866) 551-6328, or you may print this form and mail to:
Kansas Attorney General Derek Schmidt
Medicaid Fraud & Abuse Division
120 SW 10th Ave., 2nd Fl.
Topeka, KS 66612-1597


Source of Referral

Confidentiality

Beneficiary/Victim Information

Suspect Information

Is the suspect a Medicaid Provider?


Provider Network



Offense Information

City, County, State
Include as much information as possible, including witness names and contact information.

Attachments

SECURITY NOTICE: The documents you attach are being sent over the internet. Please DO NOT attach any documents that contain the following:
  • Social security numbers
  • Date of birth
  • Passwords
  • Sensitive or identifying information that could be used to compromise or steal your identity, or
  • Other information that may violate your privacy.
Please be sure to tell us about all of the documents that may support your allegations in the sections above.

If we need additional information from you, we will:
  • Contact you directly
  • Tell you what documents we need, and
  • Arrange for you to provide it to us in a more secure manner.
Upload Files
Acceptable file types include PDF, JPEG, WAV and MP3.

Verification

 

File a Complaint

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