Reporting health insurance fraud and abuse form

If you prefer to report anonymously, please call the Wellmark Ethics Hotline at 1-877-330-3667.

*Required field

Please correct the following error(s):

Your Information

First Name

Last Name

Phone Number

Fraud and/or Abuse Information

Which best describes the fraud or abuse you suspect?

Please provide additional details.

Do you have a pertinent document related to this report (CCS notes, claims, records, screen prints, etc.)?

Yes, I will send additional information to fraudandabuse@wellmark.com

No, I have nothing further to send.

Member and Patient Information (If known)

Member Name

Member ID Number

Group Name

Group Number

Provider Name

Provider Number

Patient Name

Date Of Service

Claim Number(s)

Health Care Fraud, Waste & Abuse