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Online Insurance Fraud and Abuse Report Form

To report suspected Fraud, Waste and/or Abuse, please complete the information requested below. Please be as specific as possible about the dates and details that will help support your allegation(s).


You can submit an anonymous complaint to report Fraud, Waste and/or Abuse to the Special Investigation Unit, or you may make a report of possible unethical or improper actions through our third-party vendor, EthicsPoint.


If you would prefer to print the Report Form and submit it via mail, click here to download the form and send it to:

Florida Blue
Special Investigation Unit
P.O. Box 44193
Jacksonville, FL 32231-4193



Please submit separate entries for each suspect. Items marked with an asterisk (*) are required.


Report Fraud and Abuse Online | Florida Blue Report Fraud and Abuse Online | Florida Blue
SUSPECT OF COMMITTING THE FRAUD/ABUSE:
Name (Individual or Company):

Address Line 1:
Address Line 2:
City:
State:
ZIP Code:
Telephone Number:
(xxx)xxx-xxxx
Profession:
Professional License # (if known):


LIST VICTIM(S) IF OTHER THAN YOURSELF:
Name:
Address Line 1:
Address Line 2:
City:
State:
ZIP Code:
Daytime Telephone Number:
(xxx)xxx-xxxx
BCBSF Contract # (if applicable):


COMPLAINANT (Yourself):
Your Name:
Address Line 1:
Address Line 2:
City:
State:
ZIP Code:
Daytime Telephone Number:
(xxx)xxx-xxxx
Email Address:
example@aol.com
Have you attempted to contact the person(s) suspected of committing the fraud/abuse concerning your complaint?
Yes    No If Yes, when?  


WITNESSES (Please give full name, address and phone number):
Please list all individuals who may have knowledge concerning the activity that may be fraudulent or abusive. If you need to list additional witnesses please do so in the comments section of this report.
Witness Name:
Address Line 1:
Address Line 2:
City:
State:
ZIP Code:
Home Number:
(xxx)xxx-xxxx
Work Number:
(xxx)xxx-xxxx

Witness Name:
Address Line 1:
Address Line 2:
City:
State:
ZIP Code:
Home Number:
(xxx)xxx-xxxx
Work Number:
(xxx)xxx-xxxx


*DESCRIPTION OF FRAUD OR ABUSE:
Please provide as much information as possible concerning your complaint. Be sure to include all details such as dates, times, where it took place, etc.

For your security, please enter the 6-character alpha-numeric verification code.