State of New Jersey

OIFP Fraud Reporting Form


		Note to insurance carriers: Please use OIFP referral forms for industry fraud reporting, not this reporting form, which is for public use only.

		Please complete this form as accurately as possible.To submit a confidential* "insurance fraud tip" or other information to the Office of The Insurance Fraud Prosecutor, please complete the following form. This form can be used to report suspected criminal activity of any nature.

		N.J.S.A. 17:33A-9 provides immunity from civil suit for citizens who report insurance fraud in good faith and without malice. But a person who DELIBERATELY gives FALSE information to law enforcement authorities commits an offense! N.J.S.A. 2C:28-4.

		Individuals may also apply for a reward for any tip that leads to an arrest and conviction. A reward is only payable if the tip results in a criminal conviction and is paid only for tips leading to new investigations, not cases already under investigation. Reward applications must be submitted within 30 days of the date which the applicant initially provided the information to the OIFP to be eligible for a reward. Click here to print out an Insurance Fraud Reporting Reward application.

Your Name (optional):

Your Daytime Telephone (optional):

Your E-mail (optional):

Your County or Zip Code (optional):

Name of Person or Organization Committing Medicaid or Insurance Fraud:

Their Date of Birth:

Last 4 Digits of Their Social Security #:

Their Address:

Their Employer:

Employer's Address:

Location of Fraudulent Activity:

Date(s) of Fraud:

Time(s) of Fraud:

Insurance Company:

Policy Number:

Claim Number:

Vehicle Registration Number:

Vehicle Type:

List Any Conspirators:

In your own words, describe in as much detail as possible, what a person or business did to commit Medicaid or insurance fraud. For help deciding which type of insurance fraud may have been committed, go to the Examples of Fraud page.

*This form will be kept confidential, however, any information submitted can be intercepted by a third party over the Internet. If you feel uncomfortable about submitting this form online, please contact us via U.S. mail or by calling 1-877-55-FRAUD.