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Louisiana Department of Health & Hospitals | Bruce Greenstein, Secretary

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Statewide Initiatives

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Recipient Fraud Form

Recipient's Name:

(First Name)

(Last Name)
Recipient's Gender:
Male
Female
Medicaid Number:
Recipient's Children - Names and Medicaid Numbers:

(Please fill out this field if you are reporting fraud by a parent of Medicaid recipient(s))
Recipient's Telephone Number:

(Please enter the phone number in XXX-XXX-XXXX format)
Recipient's Address:
City:
State:
Zip Code:
Suspected Fraud:
You are able to report suspected fraud complaints anonymously. But, if you would like the Medicaid Fraud Complaints Unit to contact you, please complete the fields below.
Name:
Telephone Number:
E-Mail Address: