Fresno County Department of Behavioral Health  REPORTING FORM

Please complete the form below to report a violation or a suspected non-compliance issue with regards to Fraud, Waste and Abuse of the Medicare/Medical Program. All reporting may be anonymous, however, if you wish to be contacted, please provide your contact information where indicated.

If you choose to remain anonymous, please provide sufficient, detailed, information about the violation or allegation so that we will be able to perform a thorough investigation.

After completing the form, click "Send Report".

Provide detailed information of the violation or allegation below:

* Required field

County department(s) affected:*
 

Cost Center(s) affected (provide cost center # and name):

County employee(s) involved:

Contractor(s) involved:

Approx. date that violation or allegation was discovered:*

Detailed description of the violation or allegation:*
   

Additional information that may be helpful in our investigation:
 

If you wish to be contacted, provide your contact information below:
Name:

Phone:

Mailing Address:

Email: