FRAUD HBEX 1007 Rev (05/20)
Reporting Suspected Fraud
Use this form for complaints of fraud, waste, or
abuse only. If you would like to file another type of
complaint such as problems with the website, service
enter representatives, or enrollment complaints,
please use the form located here and follow those
Questions? If you need help in another
language or would like to file your complaint
over the phone, call Covered California at
Reason for review: When making a report, provide as much detail as possible so that your report can be
fully assessed, such as: who, what, where and when.
Tell us how we can help you:
Use extra paper if you need more space to write.
1601 Exposition Blvd.,
Sacramento, CA 95815
The information requested on this form is required by Covered California, Program Integrity Division, for
purposes of identification and document processing.
Legal references authorizing maintenance of this infor
mation include Government Code, Sections 1151 and
1153; Sections 6011 and 6051 of the Internal Revenue Code; and Regulation 4, Section 404.1256, Code of
Federal Regulations, under Section 218, Title II of the Social Security Act.