Public - Fraud Allegation Portal

Report Fraud Allegation

Description of Allegation

Participant or Provider Full Name

Participant or Provider Information

Address 1

Address 2

City

State

Zip

Date of Birth

Spouse

Employer Name

Your Contact Information

(OPTIONAL)

First Name

Middle Initial

Last Name

Phone Number

Extension

Remain Anonymous:

(If box is checked, your information will only be used to contact you if more information is needed. It will not be disclosed unless required by law. OAR 461-105-0060)

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The Fraud Allegation You Want To Report

Term Definition

Description of Your Allegation (Required)
Please provide detailed allegations of your fraud complaint.

Participant or Provider Name (Required)
Please provide the name of the Participant or provider you’re referring for fraud investigation.

Spouse (Optional)
Please use this area to provide full name of spouse, partner, absent parent etc.

Employer name (Optional)
Please give detailed information on income source, employer, self-employed (name of business), address, phone #.

Your Contact Information (Optional)

Term Definition

Remain Anonymous (Optional)
If box is checked, your information will only be used to contact you if more information is needed. It will not be disclosed unless required by law. OAR 461-105-0060

First, M. I., Last Name (Optional)
You may enter your full name, so we can contact you about your comments and collect more information about this incident. You may leave these blank if you wish to remain anonymous.

Phone Number, Extension (Optional)
You may enter your phone number and phone extension (if applicable), so we can contact you about your comments and collect more information about this incident. You may leave these blank.

Email Address (Optional)
You may enter your email address so we can contact you about your comments and collect more information about this incident. You are allowed to leave this empty.