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OIG Recipient Fraud Complaint
OIG Recipient Fraud Complaint
If you suspect fraud in the Medicaid, TANF or Childcare program, please provide the information below or call 1-844-ILFRAUD.
Contact Info
Contact First Name
Contact Last Name
Contact Address
Contact City
Contact State
Contact Zip Code
Preferred Method of Contact
Contact Home Phone
Contact Work Phone
Contact Cell Phone
Contact Email
Subject Information (If the subject's employment, sources of income, household composition or date of death is relevant to your complaint, please provide the requested information below.)
Subject First Name
Subject Last Name
Subject Age
Subject Birth Date
Subject Address
Subject City
Subject State
Subject Zip
Subject SSN
Subject DHS Case Number
Referral Information (Please describe your fraud complaint in as much detail as possible, including information on any involved parties and the nature of the misconduct. The more information you are able to provide, the more likely it is that investigators will be able to pursue the matter.)
Referral Details
Notified Others
Notified Others
No
Notified Others
Yes
Agency Notified
Aging, Department of
Agriculture, Department of
Attorney General, Office of the
Auditor General
Central Management Services, Department of
Children and Family Services, Department of
Comptroller, Office of the
Corrections, Department of
Employment Security, Department of
Environmental Protection Agency
Financial and Professional Regulation, Department of
Healthcare and Family Services, Department of
Human Rights, Department of
Human Services, Department of
Insurance, Department of
Labor, Department of
Military Affairs, Department of
Public Health, Department of
Revenue, Department of
Secretary of State, Office of the
State Fire Marshal
State Police, Illinois
State Treasurer, Office of the
State Treasurer, Office of the
Veterans Affairs, Department of
Other
Program Involved (check all that apply)
Medicaid
Medicaid
Yes
Medicaid
No
Childcare
Childcare
Yes
Childcare
No
TANF
TANF
Yes
TANF
No
Other
Subject Employment Information (If the subject's employment, sources of income, household composition or date of death is relevant to your complaint, please provide the requested information below.)
Employer Name
Employer Phone
Employer Address
Employer City
Employer State
Subject's Other Income (if your complaint relates to the subject’s income, provide the information below)
Other Income Type
Alimony/Spousal Support
Capital Gain/Loss
Cash
Dividends
Gaming Proceeds
Interest
IRA Distributions
Loans
Pensions/Annuities
Rental
Royalties
SSA
SSI
Subsidies
Unemployment
Not Listed
Other Income Frequency
Other Income Amount (Enter without $)
Subject's Household Members (if your complaint relates to the subject’s household members, provide the information below)
Household Member Name
Household Member Age
Household Member Relationship
If applicable, please provide details for Additional Subject’s Household Members
Household Member 2 Name
Household Member 2 Age
Household Member 2 Relationship
Household Member 3 Name
Household Member 3 Age
Household Member 3 Relationship
Death Information (If submitting a complaint regarding a deceased recipient, please provide relevant information below.)
Death Date
Death County
Death City
Death State
File Attachments (Please upload any documentation in support of your complaint.)
Attach a file
