Office of the Vermont Attorney General

Susanne R. Young

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.

First Name *

Last Name *

Email Address *

Street & apartment/suite

City

State/Province

Zip/Postal

Phone Number

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

Provider Name *

Street & apartment/suite

City

State/Province

Zip/Postal

Provider Relationship to Victim

Other Information

Victim Name

Street & apartment/suite

City

State/Province

Zip/Postal

Occurrence Dates

*Specific Details of Your Report - Nature of harm or fraud, additional victim/provider details, locations, etc.

Do you have additional documents or information

Yes

Thank you, we will ask for copies when we contact you.

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109 State St
Montpelier, VT 05609

(802) 828-3171

Vermont’s lobbyist registration and disclosure law applies to certain communications with and activities directed at the Attorney General. Prior to any interactions with the Office of the Vermont Attorney General, you are advised to review Title 2, Sections 261-268 of the Vermont Statutes Annotated, as well as the Vermont Secretary of State’s most recent guide to compliance, available at https://www.sec.state.vt.us/elections/lobbying.aspx.