YOUR CONTACT INFORMATION Name (Required)
(Required) County Adair Andrew Atchison Audrain Barry Barton Bates Benton Bollinger Boone Buchanan Butler Caldwell Callaway Camden Cape Girardeau Carroll Carter Cass Cedar Chariton Christian Clark Clay Clinton Cole Cooper Crawford Dade Dallas Daviess Dekalb Dent Douglas Dunklin Franklin Gasconade Gentry Greene Grundy Harrison Henry Hickory Holt Howard Howell Iron Jackson Jasper Jefferson Johnson Knox Laclede Lafayette Lawrence Lewis Lincoln Linn Livingston Macon Madison Maries Marion McDonald Mercer Miller Mississippi Moniteau Monroe Montgomery Morgan New Madrid Newton Nodaway Oregon Osage Ozark Pemiscot Perry Pettis Phelps Pike Platte Polk Pulaski Putnam Ralls Randolph Ray Reynolds Ripley Saint Charles Saint Clair Saint Francois Saint Louis Saint Louis City Sainte Genevieve Saline Schuyler Scotland Scott Shannon Shelby Stoddard Stone Sullivan Taney Texas Vernon Warren Washington Wayne Webster Worth Wright Complaint Information My complaint is against a (Check One): Address
(Required) Describe in detail the information you have relating to any allegation(s) of MO HealthNet Provider fraud. Please include names and contact information of individual(s) involved, dates of alleged occurrence(s), and an explanation of how the allegation relates to MO HealthNet Provider fraud. (Required) If you do not have material(s) relating to your allegation(s), but know that such material(s) exist(s), describe it and where it may be found, including who may have possession or control over it and how that person or entity may be reached. Your Employer Information Address
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The Medicaid Fraud Control Unit ("MFCU") of the Attorney General's Office has authority to investigate and prosecute allegations of fraud against Missouri's Medicaid program. Specifically, the MFCU investigates individuals and companies that provide health care services to MO HealthNet participants.
If you wish to participate in the whistleblower program described in Section 191.907, RSMo, you must complete and return a Whistleblower Application. You will not be entitled to any proceeds of a recovery by this office if you do not do so. To request this application, please select the box below and a Whistleblower Application will be mailed to the address you provided on page one (1) of this Complaint Form.
I wish to receive a Whistleblower Application Form. Yes No