Attorney General of the State of New Mexico
Medicaid Fraud Control Division (MFCD)
Confidential Investigation Report
The following information is necessary for us to begin our investigation. Please make every attempt to provide as
much information as possible.
____ I would like my identity to remain confidential
Note on Anonymous complaints: Failure to provide name or contact information may result in no action being taken as to this matter. While
anonymous complaints will be thoroughly investigated to the best of our abilities, most investigations require follow up questions to be
answered by the complainant. Without follow up information from the complainant, in some instances, we may not be able to proceed with
an investigation. Please be advised that your name will need to be disclosed if this allegation results in civil or criminal action.
Last Name First Name Middle Initial
City State Zip
Home Phone Work Phone Mobile Phone
PREFERRED CONTACT METHOD
Text Instant Message
PREFERRED TIME TO BE CONTACTED