TENNCARE Provider Fraud

REPORT TENNCARE PROVIDER FRAUD OR ABUSE

Click here for a printable version of this form (Adobe Acrobat Reader is Required)

Send to:

STATE OF TENNESSEE
DEPARTMENT OF FINANCE & ADMINISTRATION
OFFICE OF INSPECTOR GENERAL
POST OFFICE BOX 282368
NASHVILLE, TENNESSEE 37228
FRAUD TOLL FREE HOTLINE 1-800-433-3982 · FAX (615) 256-3852
E-Mail Address: Tenncare.Fraud@state.tn.us

Please provide as much information as possible

If it is your desire, you can remain anonymous; however if you wish to speak with an OIG representative, please check here:

If so, please provide a phone number including an area code:

or email address:

Name of the Doctor, Dentist, Nurse, Pharmacy, or Other Provider You Are Reporting:

Type of Provider: (Doctor-Dentist-Nurse-Pharmacy or Other)

DEA# :(See your prescription form)

Office Street Address:

Office City:

Office State:

Office Zip Code:

Office Phone Number:

What did the provider do wrong? (In your own words, explain the problem. 1000 character max.)

Have you notified the Managed Care Contractor of this problem?

Yes No

If yes, who did you notify?

Name:

Phone:

Have you notified anyone else?

Name:

Phone:

Person Making the Complaint (This is Optional)

Name:

Zip Code:

Para información acerca de TennCare en español llame al 1-800-669-1851