Home > About Blue Cross > Health care fraud > Report suspected fraud

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Please include your contact information if you would like a response.

You may remain anonymous. All information we receive is strictly confidential.

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Please fill in as much information as possible.

• "Your information" refers to you, the person reporting the fraud. As noted in the form, completing this section is optional if you wish to remain anonymous.
• "Insured's information" refers to the person who carries the insurance.

Your information (optional — you may remain anonymous):
First name:	Last name:
Street address:	City:
State:	Zip code:
E-mail address:	Phone number:
Evening phone number:
Insured's information (Person who carries the insurance):
First name:	Last name:
Contract number (This number may be found on the BCBSM ID card and any Explanation of Benefits statement.):
Street address:	City:
State:	ZIP code:
Phone number:
Person or company complaint is about:
Name:	Street address:
City:	State:
ZIP code:	Phone number:
Identifying characteristics:
Sex: Male Female	Race:
Weight:	Height:
Known associates:	Date of incident(s):
Summary of complaint:
(Press "Enter" at the end of each line.)