Investigations MEDIC Complaint Form 2025

1. Click ‘Get Form’ to open the Investigations MEDIC Complaint Form in the editor.
2. Begin by selecting whether your complaint pertains to Medicare Advantage (Part C), Prescription Drug Benefit (Part D), or both. This helps categorize your issue accurately.
3. Fill in your contact information, including your name, phone number, email, and organization details. Ensure this information is accurate for follow-up communication.
4. Provide beneficiary information such as their name, HICN#, MBI#, and address. Indicate if the beneficiary is a subject of the complaint and if you have any contact reports on them.
5. In the 'Description of Subject/Suspect of Fraud' section, enter details about the suspect including NPI, Tax ID, and business information. Be specific to enhance clarity.
6. Detail the complaint specifics under 'Complaint Details', including potential Medicare program exposure and any prior case numbers. Attach additional documentation as needed.
7. Finally, review all entries for accuracy before submitting. You can save your progress and return later if necessary.

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