Anti-Fraud

Fraud and Abuse Tip Referral Form

Please complete this form if you believe that fraud and/or abuse may have occured to you, a family member, or a coworker. Any individual, entity, or group that is employed by or provides a service on behalf of AmeriHealth New Jersey (including employees, subscribers, professional providers, employees of a provider, facilities, or billing companies) may be the subject of the complaint.

 

The form will be forwarded to the Corporate and Financial Investigations Department for review/evaluation. You will receive a response to your complaint, unless you choose to remain anonymous. If you would like to fax a complaint, the number is 215‑238‑2287.

Your Information - Not Required

 

 

 

 

 

 

 

 

 

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Subject You Are Reporting

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Provider Member Employee Group Other

 

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Select your plan AmeriHealth HMO AmeriHealth PPO AmeriHealth POS AmeriHealth POS Plus AmeriHealth POS Direct AmeriHealth 65 Other

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Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

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Summary of Complaint

 

Services Denied

Would you like to remain anonymous?

 YES    NO

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Required

 

SUBMIT