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BlueCross BlueShield of Alabama

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:
Email Address:

* Indicates Required Fields