You may choose not to include your name, and your report may remain anonymous and confidential.

INSTRUCTIONS: Please provide as much information and detail as possible regarding the allegation. After completing this form, please click "Submit" and the information will be sent securely to Simply Healthcare Plans’ Special Investigations Unit (SIU). Any additional information or attachments can be e-mailed to, or

If you have questions on how to complete this form or would like to report your allegation verbally, please contact the Fraud, Waste and Abuse Hotline at 877-253-9251.

Please provide us with your contact information (Optional):

Please describe the incident you are reporting including, dates, locations, names of individuals, health plans and/or providers. If you have any supporting evidence of the incident please also include in your description.