EthicsPoint

ETHICSPOINT IS NOT A 911 OR EMERGENCY SERVICE.
Do not use this site to report events presenting an immediate threat to life or property. Reports submitted through this service may not receive an immediate response. If you require emergency assistance, please contact your local authorities.

* Yes - I agree to the Terms and Conditions of making this report.

Please provide information as follows:
( * Required fields )

Organization/Tier:	SCAN / SIU
Location where incident occurred:	Physical address, branch and/or store number
City:	State/Province:
Zip/Postal Code:
Country:

* Are you an employee of SCAN / SIU?

Yes No

* Do you wish to remain ANONYMOUS for this report?

Yes No

If you want SCAN / SIU to know your identity, please complete the following:

Your Name:


First Name	Last Name

Your Phone Number:

Your Email Address:

Best time for communication with you:

While not all fields are required, please include as much information applicable, as it may hinder our ability to perform an investigation.

Report - Healthcare Related Fraud, Waste & Abuse

* Please identify person(s)/entity involved or aware of the fraud, waste, or abuse

<font color="#000000">Example:<br><br>John Doe, Director of Internal Audit<br>Unknown, Unknown, Night Supervisor</font>

	First Name	Last Name		Title
#1			-
#2			-
#3			-

Approximate start date of incident/ service


	Format: mm/dd/yyyy

Approximate end date of incident/ service


	Format: mm/dd/yyyy

Is management aware of this problem?

Yes No Do Not Know / Do Not Wish To Disclose

Select your department

Member Name

Member ID

Provider NPI

Provider ID

* Please provide all available details.

Please take your time and provide as much detail as possible, but exercise care to not provide details that may reveal your identity unless you wish to do so. It may be important to know if you are the only person aware of this situation.

* General nature of the Fraud, Waste, or Abuse (Max: 200 characters)

	Why do you think this is Fraud, Waste, or Abuse?

What have you done so far to resolve the matter? Provide a summary

If you have a document or file that supports your report, most common file types can be uploaded:

When you submit the report, you will be assigned a Report Key and be asked to set up a password. Please note both and check back in 5 business days in case there are further questions.

Please choose a password for this report:
* Password:
* Re-enter Password:
Your passwords must match and be at least four characters long.