U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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                   Report Fraud, Waste, Abuse and Mismanagement

Please complete the following information:





Contact information: If you wish to remain anonymous your contact information will not be revealed. You are not required to submit contact information.
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Summary of Allegations:

Identify the person(s) and/or entity(ies) involved.


Describe your allegation. Include specific detail in order to evaluate the allegation. Do you believe it is fraud, waste, abuse or mismanagement? Do you believe it is a criminal violation?


Identify the IHS Area, facility or location where the alleged actions occurred. Is the facility federally or tribally operated?


Identify a timeframe(s) for the allegation(s). Provide specific dates if known.


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Please identify.





Please identify.


Please explain.


: Please include any other pertinent information.


   
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