Online Insurance Fraud and Abuse Report Form

To report suspected Fraud, Waste and/or Abuse, please complete the information requested below. Please be as specific as possible about the dates and details that will help support your allegation(s).

You can submit an anonymous complaint to report Fraud, Waste and/or Abuse to the Special Investigation Unit, or you may make a report of possible unethical or improper actions through our third-party vendor, EthicsPoint.

If you would prefer to print the Report Form and submit it via mail, click here to download the form and send it to:

Florida Blue
Special Investigation Unit
P.O. Box 44193
Jacksonville, FL 32231-4193

Please submit separate entries for each suspect. Items marked with an asterisk (*) are required.

Optional

SUSPECT OF COMMITING THE FRAUD/ABUSE:

Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
(xxx)xxx-xxxx
Optional
Optional
Optional

LIST VICTIM(S) IF OTHER THAN YOURSELF:

Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
(xxx)xxx-xxxx
Optional
Optional

COMPLAINANT(Yourself):

Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
(xxx)xxx-xxxx
Optional
Optional
example@aol.com
Have you attempted to contact the person(s) suspected of committing the fraud/abuse concerning your complaint?
Optional
Optional

WITNESSES ( Please give full name, address and phone number):

Please list all individuals who may have knowledge concerning the activity that may be fraudulent or abusive.If you need to list additional witnesses please do so in the comments section of this report. 

Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional
Optional

Please provide as much information as possible concerning your complaint. Be sure to include all details such as dates,times, where it took place, etc.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.