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BlueCross BlueShield of Alabama
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Report Suspected Fraud and Abuse
Please complete the following form if you suspect an incident of fraud or abuse has occurred.
Who do you suspect is committing fraud?
Name:
*
Type of Physician:
(If Applicable)
Address:
*
City:
*
State:
*
Zip Code:
*
Phone Number:
What fraudulent activity occurred?
(Please describe in as much detail as possible.)
*
Contract Number:
(If the fraud involves services provided to you.)
Any additional comments?
May we contact you?
(If additional information is necessary.)
Name:
Daytime Phone Number:
E-mail Address:
*
Indicates Required Fields