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Office of the Vermont Attorney General

Medicaid Fraud Report Form

Medicaid Fraud Report Form

Vermont Office of Attorney General
109 State Street
Montpelier, VT 05609-1001

This online form requests the necessary information for investigating and potentially prosecuting your allegation. We need as much information as you can provide regarding the "who, what, when, where, and how" of the related incident. Please tell us as much as you know.
Any compliant form or associated documents may become public record when submitted to this office.

Your Information (fields with an asterisk * are required.) We must be able to contact you in case we need more information.

Street & apartment/suite
Street & apartment/suite
City
State/Province
Zip/Postal
Provider or Person Committing Fraud or Abuse Information

The Medicaid Fraud Unit does not investigate individuals who receive services from Medicaid. For more information, contact the Economic Services Division of the Agency of Human Health.

Provider or Person Committing Fraud or Abuse Information

Street & apartment/suite
Street & apartment/suite
City
State/Province
Zip/Postal

Other Information

Street & apartment/suite
Street & apartment/suite
City
State/Province
Zip/Postal
Do you have additional documents or information
Thank you, we will ask for copies when we contact you.