Fillable Referral Form Fraud, Waste and Abuse (Sunshine Health)

Fill Online, Printable, Fillable, Blank Referral Form Fraud, Waste and Abuse (Sunshine Health) Form

Use Fill to complete blank online SUNSHINE HEALTH pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Referral Form Fraud, Waste and Abuse (Sunshine Health)

On average this form takes 3 minutes to complete

The Referral Form Fraud, Waste and Abuse (Sunshine Health) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 12 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Sunshine Health forms online.

BROWSE SUNSHINE HEALTH FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1301 International Pkwy.
Suite 400
Sunrise, FL 33323
Referral Form Fraud, Waste and Abuse
Please note that the following information is confidential. However, by disclosing your
name, you may be contacted for additional information and may be required to testify by
Centene Corporation or by the State’s Department of Insurance.
To submit an anonymous referral, please fill in the information below and either mail it to
Tamela I. Perdue, Compliance Officer at Sunshine Health, 1301 International Pkwy.,
Suite 400, Sunrise, FL 33323 or Centene Corporation, Attn: Compliance Department,
7700 Forsyth Blvd., St. Louis, MO 63105.
If you do not wish to remain anonymous, please fill out the information below and email it
to Tamela I. Perdue at Compliancefl@Centene.com.
If you have concerns about submitting the referral to the Compliance Officer for Sunshine
Health, please forward the information to Centene Corporation, Attn: Compliance
Department. You may also call the FWA hotline number at 1-866-685-8664 or Centene/
Sunshine Health’s Compliance Hotline at 1-800-345-1642.
Name: _______________________________________________________________
Date: __________ Plan: _______________ Phone Number: _____________
Provider/Member Name: _________________________________________________
Provider/Member ID (if available): __________________________________________
If a provider, what type of provider/specialty: ________________________________
1-866-796-0530
TDD/TTY 1-800-955-8770
SunshineHealth.com
What is the relationship of the informant to the provider/member?
What is the potential WAF Issue?
How did you become aware of the potential issue?
Have you discussed the potential issue with anyone else?
If yes, with whom?
If you have any additional information that would be helpful during the
investigation, please list it below:
1-866-796-0530
TDD/TTY 1-800-955-8770
SunshineHealth.com
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Referral Form Fraud, Waste and Abuse (Sunshine Health)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 31 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document