Medicaid Fraud and Patient Abuse Complaint Form

To file a Medicaid fraud or patient abuse complaint, please fill out the required information below and select the submit button once complete. This allows us to receive your information electronically.

If you would prefer to submit a complaint by mail, you can print a pdf version of the complaint form here. Once you fill out the form, please mail it to:

Office of the Attorney General
Attn: Medicaid Fraud and Patient Abuse Unit
2115 State Capitol
Lincoln, NE 68509-8920

Personal Information

Date of Referral: Required

First Name: Required

Last Name: Required

Email Address: Required

Address: Required

Phone Number: Required

City: Required

State: Required

Zip Code: Required

Facility Provider

Name: Required

Address:

City: Required

State: Required

Zip Code:

Phone Number:

Other Parties Involved (if applicable)

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Phone Number:

Allegation/Concern

Describe the suspected fraudulent or abusive activities (including background, persons involved, events, dates and locations). Be sure to include the who, what, when, where, why and how of the situation. Please provide as much information as possible. Required

Other Agencies Notified

Disclaimer

The information given above is true to the best of my knowledge and belief. By submitting this form, I authorize the Attorney General’s Office to use the information given in any manner which is determined necessary. I understand that the Attorney General's Office is not my private attorney, but represents the State in enforcing laws designed to protect Nebraska’s Medicaid program from fraud and to protect the residents of Medicaid-funded facilities from abuse, neglect or exploitation.

Mike Hilgers

Nebraska Attorney General