Nassau County Online Forms

2. Regarding Medicaid Fraud
   Medicaid is a program that provides healthcare to people who are unable to pay for such care. Medicaid Fraud occurs when a health care provider provides false information to obtain payment from the Medicaid program.
   
   . Below is an online form requesting the necessary information for investigating and potentially prosecuting the 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.
   
   You may also call our Medicaid Fraud Hotline at (888) 633-4311.
4. Your Name (Optional)
6. Your Email (Optional)
8. Name of Provider or Person Committing Fraud (required):*
   Please provide the name of the Provider or Person Committing Fraud.
10. Their Address
12. Address
14. Their City
15. Their State
16. Their Zip
18. Their Telephone Number
20. Date of Occurrence (if Applicable)
    Date of Occurrence (if Applicable)

    Date of Occurrence (if Applicable)
22. Specific Details of Your Concern: (Required)*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field