Wyoming Medicaid Provider Fraud & Abuse Incident Report/Case Referral
The Wyoming Attorney General's Office and the Wyoming Medicaid Fraud Control Unit are serious about preventing Medicaid Fraud and the abuse, neglect, and exploitation of vulnerable adults. You may use this form to report fraud and abuse to us.

If you have any questions about Medicaid Fraud, or patient abuse, neglect, or exploitation, please visit http://ag.wyo.gov/medicaid-fraud-control-unit/faq, or call us at 307-777-3444 or 1-800-378-0345.

Please provide as much information as possible. This will help us properly review the matter. Incomplete information may prevent or delay a thorough review of this matter.

Date of Referral *
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Referred by:
We may need to contact you to obtain additional information about this report. All complaints submitted to the Medicaid Fraud Control Unit are treated confidentially. We make every effort to protect the identify of individuals who submit complaints. Complaints are shared only within the Unit for the purpose of evaluating your complaint, and when required by law or judicial processes.

You may remain anonymous if you choose. However, a lack of contact information may prevent the Unit from conducting a comprehensive review of your complaint and will prevent further communication between you and the Unit. If you wish to enter your information anonymously, please take care to withhold any personally identifiable information from your complaint narrative.

Whistleblower protection: Wyoming Statute § 42-4-304(b) provides protections for employees, agents, or contractors reporting false Medicaid claims reports to the Medicaid Fraud Control Unit.

Name:
Your answer
Street Address:
Your answer
City:
Your answer
State:
Zip Code:
Your answer
Phone Number:
Your answer
Email Address:
Your answer
Relationship to the victim:
Your answer
Relationship to the provider:
Your answer
I am reporting: *
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