Special Investigations Referral

To submit a report directly to the SCAN Special Investigations Unit, fill this form out completely. If you wish to report anonymously, you do not have to provide your name or identification number (we do ask that you indicate if you are a member, employee or provider). Please provide as many details as possible. When you’ve completed the form, hit the submit button. We suggest you print a copy for your records, too.
Referral Source Information
Members, Providers, and Others Involved
Allegation Issue Details