The Official Website of the Attorney General of Massachusetts

Martha Coakley, Attorney General

Medicaid Fraud Complaint or Fraud Reporting Form


Office of the Attorney General
Medicaid Fraud Division
One Ashburton Place
Boston, MA 02108

If you seek accommodation due to a disability, or need to speak with someone urgently, please call the Medicaid Fraud Complaint Line at (617) 963-2360. All fields are required unless otherwise noted. Please note that the Attorney General'€™s Office does not represent private citizens seeking private resolutions.

Your Contact Information:


  
  
  
  

(Example: 123-456-7890)
(NOTE: Please provide a working daytime telephone number.)
  
  
   
   
(Optional: You are not required to provide this information to file a complaint, but having it may help us serve you more effectively.)

Subject of the complaint:


  
  
  

(Example: 123-456-7890)
  

Information on your complaint:


 
 
 
 

(Note: 3000 characters maximum; 0 characters entered, 3000 characters remaining.)
 
 
 
 
 
 
 

  
  
(mm/dd/yyyy)
  
  
  
 

(Note: 300 characters maximum; 0 characters entered, 300 characters remaining.)

 
 Yes  No


 

Instructions:


DO NOT SEND ORIGINALS. Your documents will NOT be returned to you. Please retain a copy for your records and send us photocopies or an electronic scan of any documentation you think may be helpful in reviewing your complaint.

Please do NOT include financial account numbers, credit or debit card numbers, your social security number, etc., or other sensitive personal information. We will contact you if we need any of this information.

Read the Following Before Signing Below:


I. Disclosure of Your Complaint.
Public Record. Your complaint, and any documents submitted with your complaint, may be considered a public record and available to any member of the public upon request. In response to such a request, we generally will not disclose your name, address, phone number, or any other sensitive personal information that identifies you and will not disclose this form in response to any request that specifically seeks the complaint you submitted.
 
Disclosure to Other Entities. Your complaint and any related information may be disclosed in its entirety to other law enforcement and regulatory agencies.
 
II. Consulting With a Private Attorney.
The AGO cannot give you legal advice and is not able to be your private attorney, but represents the public interest. If you have any questions concerning your individual legal rights or responsibilities you should contact a private attorney.
 
 
By filling in my name above and checking this box, I acknowledge that I have read and understood the provisions above and certify that the information I have provided is true and correct to the best of my knowledge, and I adopt this as my online signature.