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Suspected Fraudulent Activity Referral Form

If you suspect long-term care insurance fraud is being committed, please complete the form below and click the submit button:

Required fields *

Policyholder Information

Your Information

Please provide your information so we can contact you if we have questions. Your identity will be protected to the extent allowed. You have the right to remain anonymous when reporting suspected fraud.

Incident Details

Please provide details about the activities that may be fraud, waste, or abuse. Some examples are:

  • Billing for services not received

  • Documents that have been falsified

Your submission has been delivered.

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