SPECIAL INVESTIGATIONS UNIT (SIU)
FRAUD, WASTE, AND ABUSE (FWA) REPORTING FORM


All referrals will be submitted directly to the Special Investigations Unit (SIU). Please complete this form with as much detail and information as possible.

Referral Information

Date Submitted: 4/11/2026

Subject Information


Allegation Information

Date or Date Range of the Incident:

Please be as specific as possible by providing detailed information, and the who, what, where, why, and how.

Are there other witnesses to this incident?

Supporting Documentation and/or Attachments

If you prefer to submit the Fraud, Waste, and Abuse Reporting Form by Mail or Email, feel free to send the information and all attachments to the following:
University of Utah Health Plans
Attention: Special Investigations Unit
PO Box 45180
Salt Lake City, UT 84145-0180

Email: HealthPlansReportFraud@utah.edu