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Have you been a victim of fraud? Share your story with us by completing the form below and each month we'll select personal stories to highlight and investigate. If selected, you'll win $250 to help pay your medical expenses. We promise not to send you junk mail and we will never sell your information to any organization.

Your Information

First Name *

Last Name *

Email Address *

Phone Number *

Provider Information

Provider Name *

Street *

City *

State *

Zip *

Story *

(type the code from the image)

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*Legal Notice: Provider names and Private Health Information (PHI) will remain confidential. All submissions will we entered into SHCF.com's fraud victim database and investigated by HealthCare Insight's (HCI) Clinical Investigative Unit (CIU). If you have any questions about this form or information disclosed, please email us at support@stophealthcarefraud.com

Become a SHCF.com Fraud Fighter and get members only news, videos and fraud tips. As a member of SHCF.com, you'll be the first to know about breaking news and free fraud resources through our quarterly newsletter. We promise not to send you junk mail and we will never sell your information to any organization.

First name *

Last name *

Email *

Age Range *

Role *

Address

City

State

Zip code

* Required Fields