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Report Provider Fraud

Prevent Fraud in Washington State

Do you wish to file a complaint with L&I about a provider you believe is taking advantage of the workers' compensation system? Let us know by completing this form. We take action against fraud because it increases costs for everyone. Provide as much information as you can. We will need it to pursue your complaint.

Information about the provider you are reporting
Provider's First Name:
Provider's Last Name:
Street Address:
Address (cont.):
City, State, Zip +4    -
Country:
Work Phone:
- include area code
000-000-0000
Provider Business/Clinic Name:
Provider Type:
Physician Physical/Occupational Therapist
Chiropractor Hearing Aid Provider
Pharmacy Nursing Services
Interpreter Mental Health
Home Care Durable Medical Equipment
Other
Types of Billing:
Double Billing Billing for services not provided
Upcoding Unrelated conditions treated
Unlicensed provider Unbundled services
Code manipulation    
Other
Summary:
Please summarize your complaint, providing any details not listed above.
Can you provide
evidence of fraud?
Yes No Possibly
Is the provider involved in any other type of fraudulent activity that you are aware of?
Yes No Possibly
Are you aware of any other people who have knowledge of the reported fraudulent behavior?
Yes No Possibly
L&I may receive a request for public records under Washingtons Public Records Act for records relating to your complaint. If you include your name and contact information in your complaint, we will need to disclose it to the person requesting the complaint records. If you prefer not to share your contact information but would like to share additional information with the department about this complaint, please note the referral number and call 1-888-811-5974 (Select Option "4").
Your Information  
Your Name:
Your Daytime Phone: - include area code 000-000-0000
Your Evening Phone:
- include area code
000-000-0000
Your Address:
City, State, Zip +4 -
Email:
How did you learn about this referral page. Please select from the following:
Click to submit > 

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