{"id":6562,"date":"2023-10-25T11:26:01","date_gmt":"2023-10-25T16:26:01","guid":{"rendered":"https:\/\/healthwellnessok.com\/?page_id=6562"},"modified":"2025-07-08T15:29:39","modified_gmt":"2025-07-08T20:29:39","slug":"fraud-alert-form","status":"publish","type":"page","link":"https:\/\/healthwellnessok.com\/fraud-alert-form","title":{"rendered":"Fraud Alert Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6562\" class=\"elementor elementor-6562\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d00e472 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d00e472\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7137633\" data-id=\"7137633\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c65a8f2 elementor-widget elementor-widget-formidable\" data-id=\"c65a8f2\" data-element_type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='formidable-css' href='https:\/\/healthwellnessok.com\/wp-content\/plugins\/formidable\/css\/formidableforms2.css?ver=12301820' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_3_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_fraud-reporting\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"fraud-reporting\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"8d13f33aac\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/6562\" \/><div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first vertical_radio frm_other_container\">\r\n\t<div  id=\"field_checkbox-1_label\" class=\"frm_primary_label\">What is the complaint regarding?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_checkbox-1_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-0\">\t\t\t<label  for=\"field_checkbox-1-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][]\" id=\"field_checkbox-1-0\" value=\"Healthcare Fraud\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   aria-required=\"true\"  \/> Healthcare Fraud<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-1\">\t\t\t<label  for=\"field_checkbox-1-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][]\" id=\"field_checkbox-1-1\" value=\"Fraud, waste or abuse by an HWC employee\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   \/> Fraud, waste or abuse by an HWC employee<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-2\">\t\t\t<label  for=\"field_checkbox-1-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][]\" id=\"field_checkbox-1-2\" value=\"Whistleblower retaliation\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   \/> Whistleblower retaliation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-3\">\t\t\t<label  for=\"field_checkbox-1-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][]\" id=\"field_checkbox-1-3\" value=\"Grant\/Contract fraud\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   \/> Grant\/Contract fraud<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-4\">\t\t\t<label  for=\"field_checkbox-1-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][]\" id=\"field_checkbox-1-4\" value=\"Quality of Care\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   \/> Quality of Care<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-5\">\t\t\t<label  for=\"field_checkbox-1-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][]\" id=\"field_checkbox-1-5\" value=\"Medical Identity theft\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   \/> Medical Identity theft<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_16-other_7\">\t\t\t<label  for=\"field_checkbox-1-other_7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[16][other_7]\" id=\"field_checkbox-1-other_7\" value=\"Other\"  data-reqmsg=\"What is the complaint regarding? cannot be blank.\" data-invmsg=\"What is the complaint regarding? is invalid\"   \/> Other<\/label><label for=\"field_checkbox-1-other_7-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_checkbox-1-other_7-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][16][other_7]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 vertical_radio frm_other_container\">\r\n\t<div  id=\"field_checkbox-2_label\" class=\"frm_primary_label\">Program\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_checkbox-2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-0\">\t\t\t<label  for=\"field_checkbox-2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-0\" value=\"Administration\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   aria-required=\"true\"  \/> Administration<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-1\">\t\t\t<label  for=\"field_checkbox-2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-1\" value=\"Head Start\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Head Start<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-2\">\t\t\t<label  for=\"field_checkbox-2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-2\" value=\"Optometry\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Optometry<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-3\">\t\t\t<label  for=\"field_checkbox-2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-3\" value=\"Medical\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Medical<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-4\">\t\t\t<label  for=\"field_checkbox-2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-4\" value=\"Dental\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Dental<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-5\">\t\t\t<label  for=\"field_checkbox-2-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-5\" value=\"Substance Use Disorder\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Substance Use Disorder<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-6\">\t\t\t<label  for=\"field_checkbox-2-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][]\" id=\"field_checkbox-2-6\" value=\"Pharmacy\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Pharmacy<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_18-other_7\">\t\t\t<label  for=\"field_checkbox-2-other_7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[18][other_7]\" id=\"field_checkbox-2-other_7\" value=\"Other\"  data-reqmsg=\"Program cannot be blank.\" data-invmsg=\"Program is invalid\"   \/> Other<\/label><label for=\"field_checkbox-2-other_7-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_checkbox-2-other_7-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][18][other_7]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_select-1\" id=\"field_select-1_label\" class=\"frm_primary_label\">Facility\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[20]\" id=\"field_select-1\"  data-reqmsg=\"Facility cannot be blank.\" aria-required=\"true\" data-invmsg=\"Facility is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Checotah\">Checotah<\/option><option  value=\"Eufaula\">Eufaula<\/option><option  value=\"Poteau\">Poteau<\/option><option  value=\"McAlester\">McAlester<\/option><option  value=\"Sallisaw\">Sallisaw<\/option><option  value=\"Stigler\">Stigler<\/option><option  value=\"Warner\">Warner<\/option><option  value=\"Wilburton\">Wilburton<\/option><option  value=\"Checotah Pharmacy\">Checotah Pharmacy<\/option><option  value=\"Eufaula Pharmacy\">Eufaula Pharmacy<\/option><option  value=\"Hoover Drug\">Hoover Drug<\/option><option  value=\"Head Start - Briggs\">Head Start - Briggs<\/option><option  value=\"Head Start - Checotah\">Head Start - Checotah<\/option><option  value=\"Head Start - Grand View\">Head Start - Grand View<\/option><option  value=\"Head Start - Hartshorne\">Head Start - Hartshorne<\/option><option  value=\"Head Start - McAlester Early\">Head Start - McAlester Early<\/option><option  value=\"Head Start - McAlester Washington\">Head Start - McAlester Washington<\/option><option  value=\"Head Start - McCurtain\">Head Start - McCurtain<\/option><option  value=\"Head Start - Woodall\">Head Start - Woodall<\/option><option  value=\"Head Start - Quinton\">Head Start - Quinton<\/option><option  value=\"Head Start - Roland\">Head Start - Roland<\/option><option  value=\"Head Start - Ryal\">Head Start - Ryal<\/option><option  value=\"Head Start - Sallisaw Early\">Head Start - Sallisaw Early<\/option><option  value=\"Head Start - Sallisaw\">Head Start - Sallisaw<\/option><option  value=\"Head Start - Stigler Early\">Head Start - Stigler Early<\/option><option  value=\"Head Start - Stigler\">Head Start - Stigler<\/option><option  value=\"Head Start - Tahlequah Early\">Head Start - Tahlequah Early<\/option><option  value=\"Head Start - Tahlequah\">Head Start - Tahlequah<\/option><option  value=\"Head Start - Tenkiller\">Head Start - Tenkiller<\/option><option  value=\"Head Start - Vian\">Head Start - Vian<\/option><option  value=\"Head Start - Westville Early\">Head Start - Westville Early<\/option><option  value=\"Head Start - Westville\">Head Start - Westville<\/option><option  value=\"Head Start - Wilburton\">Head Start - Wilburton<\/option><option  value=\"Head Start - Stigler Administration\">Head Start - Stigler Administration<\/option><option  value=\"Head Start - Tahlequah Administration\">Head Start - Tahlequah Administration<\/option>\t<\/select>\n\t\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_date-1\" id=\"field_date-1_label\" class=\"frm_primary_label\">Date activity occurred\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_date-1\" name=\"item_meta[21]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Date activity occurred cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date activity occurred is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 vertical_radio\">\n\t<div  id=\"field_radio-1_label\" class=\"frm_primary_label\">Is the activity still occurring?\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_radio-1_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_22-0\">\t\t\t<label  for=\"field_radio-1-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_radio-1-0\" value=\"Yes\"\n\t\t   data-reqmsg=\"Is the activity still occurring? cannot be blank.\" data-invmsg=\"Is the activity still occurring? is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-1\">\t\t\t<label  for=\"field_radio-1-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_radio-1-1\" value=\"No\"\n\t\t   data-reqmsg=\"Is the activity still occurring? cannot be blank.\" data-invmsg=\"Is the activity still occurring? is invalid\"  \/> No<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\n\t<label for=\"field_textarea-1\" id=\"field_textarea-1_label\" class=\"frm_primary_label\">When did the activity end?\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/label>\n\t<textarea name=\"item_meta[23]\" id=\"field_textarea-1\" rows=\"5\"  data-reqmsg=\"When did the activity end? cannot be blank.\" aria-required=\"true\" data-invmsg=\"When did the activity end? is invalid\" aria-invalid=\"false\"  ><\/textarea>\n\t\n\t\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first vertical_radio\">\n\t<div  id=\"field_radio-2_label\" class=\"frm_primary_label\">Has the concern been previously reported?\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_radio-2_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_24-0\">\t\t\t<label  for=\"field_radio-2-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[24]\" id=\"field_radio-2-0\" value=\"Yes\"\n\t\t   data-reqmsg=\"Has the concern been previously reported? cannot be blank.\" data-invmsg=\"Has the concern been previously reported? is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_24-1\">\t\t\t<label  for=\"field_radio-2-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[24]\" id=\"field_radio-2-1\" value=\"No\"\n\t\t   data-reqmsg=\"Has the concern been previously reported? cannot be blank.\" data-invmsg=\"Has the concern been previously reported? is invalid\"  \/> No<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_25_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 vertical_radio\">\n\t<div  id=\"field_radio-3_label\" class=\"frm_primary_label\">Identify the party responsible for the activity you are reporting.\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_radio-3_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_25-0\">\t\t\t<label  for=\"field_radio-3-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_radio-3-0\" value=\"Business\"\n\t\t   data-reqmsg=\"Identify the party responsible for the activity you are reporting. cannot be blank.\" data-invmsg=\"Identify the party responsible for the activity you are reporting. is invalid\"  \/> Business<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-1\">\t\t\t<label  for=\"field_radio-3-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_radio-3-1\" value=\"Individual\"\n\t\t   data-reqmsg=\"Identify the party responsible for the activity you are reporting. cannot be blank.\" data-invmsg=\"Identify the party responsible for the activity you are reporting. is invalid\"  \/> Individual<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_25-2\">\t\t\t<label  for=\"field_radio-3-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[25]\" id=\"field_radio-3-2\" value=\"Unsure\"\n\t\t   data-reqmsg=\"Identify the party responsible for the activity you are reporting. cannot be blank.\" data-invmsg=\"Identify the party responsible for the activity you are reporting. is invalid\"  \/> Unsure<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_26_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\n\t<label for=\"field_text-3\" id=\"field_text-3_label\" class=\"frm_primary_label\">Name(s) of Individual\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/label>\n\t<input  type=\"text\" id=\"field_text-3\" name=\"item_meta[26]\" value=\"\"  data-reqmsg=\"Name(s) of Individual cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name(s) of Individual is invalid\" aria-invalid=\"false\"   \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_27_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio\">\n\t<div  id=\"field_radio-4_label\" class=\"frm_primary_label\">Is there anyone who can corroborate the report?\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_radio-4_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_27-0\">\t\t\t<label  for=\"field_radio-4-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_radio-4-0\" value=\"Yes\"\n\t\t   data-invmsg=\"Is there anyone who can corroborate the report? is invalid\"  \/> Yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_27-1\">\t\t\t<label  for=\"field_radio-4-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[27]\" id=\"field_radio-4-1\" value=\"No\"\n\t\t   data-invmsg=\"Is there anyone who can corroborate the report? is invalid\"  \/> No<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_textarea-2\" id=\"field_textarea-2_label\" class=\"frm_primary_label\">Contact Information\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<textarea name=\"item_meta[28]\" id=\"field_textarea-2\" rows=\"5\"  data-invmsg=\"Contact Information is invalid\" aria-invalid=\"false\"  ><\/textarea>\n\t\n\t\n<\/div>\n<div id=\"frm_field_29_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\n\t<label for=\"field_textarea-3\" id=\"field_textarea-3_label\" class=\"frm_primary_label\">Please describe the fraudulent activity in your own words.\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/label>\n\t<textarea name=\"item_meta[29]\" id=\"field_textarea-3\" rows=\"5\"  data-reqmsg=\"Please describe the fraudulent activity in your own words. cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please describe the fraudulent activity in your own words. is invalid\" aria-invalid=\"false\"  ><\/textarea>\n\t\n\t\n<\/div>\n<div id=\"frm_field_30_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_upload-1\" id=\"field_upload-1_label\" class=\"frm_primary_label\">Any helpful documents (or evidence)\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"hidden\"  data-invmsg=\"Any helpful documents (or evidence) is invalid\" aria-invalid=\"false\"   name=\"item_meta[30]\"  value=\"\" data-frmfile=\"30\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file30_dropzone\" role=\"group\"  aria-describedby=\"frm_desc_field_upload-1\">\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file30\" id=\"field_upload-1\"\n\t\t\t data-invmsg=\"Any helpful documents (or evidence) is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Any helpful documents (or evidence). Drop a file here or click to upload. Maximum file size: 4.19MB\">Drop a file here or click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Any helpful documents (or evidence). Choose File. Maximum file size: 4.19MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 4.19MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\n\t<div class=\"frm_description\" id=\"frm_desc_field_upload-1\">Please upload any supporting files here.<\/div>\n\t\n<\/div>\n<div id=\"frm_field_31_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_three_col\">\n\t<div  id=\"field_radio-5_label\" class=\"frm_primary_label\">Consent to disclose your identity\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\n\t<\/div>\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_radio-5_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_31-0\">\t\t\t<label  for=\"field_radio-5-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_radio-5-0\" value=\"No restrictions. Confidentiality and anonymity is not requested. If necessary, you may contact me for additional information and there are no restrictions on the release of my contact information.\"\n\t\t   data-reqmsg=\"Consent to disclose your identity cannot be blank.\" data-invmsg=\"Consent to disclose your identity is invalid\"  \/> No restrictions. Confidentiality and anonymity is not requested. If necessary, you may contact me for additional information and there are no restrictions on the release of my contact information.<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_31-1\">\t\t\t<label  for=\"field_radio-5-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_radio-5-1\" value=\"I wish to remain Confidential. You may contact me for additional information, but please keep my name confidential and do not share it outside of the HWC Compliance Office. I also understand that HWC may still need to disclose my identity if required by law or if deemed necessary to the investigation.\"\n\t\t   data-reqmsg=\"Consent to disclose your identity cannot be blank.\" data-invmsg=\"Consent to disclose your identity is invalid\"  \/> I wish to remain Confidential. You may contact me for additional information, but please keep my name confidential and do not share it outside of the HWC Compliance Office. I also understand that HWC may still need to disclose my identity if required by law or if deemed necessary to the investigation.<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_31-2\">\t\t\t<label  for=\"field_radio-5-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[31]\" id=\"field_radio-5-2\" value=\"I wish to remain Anonymous. I understand that HHS-OIG will not be able to contact me and, as a result, may not be able to thoroughly investigate or resolve my complaint.\"\n\t\t   data-reqmsg=\"Consent to disclose your identity cannot be blank.\" data-invmsg=\"Consent to disclose your identity is invalid\"  \/> I wish to remain Anonymous. I understand that HHS-OIG will not be able to contact me and, as a result, may not be able to thoroughly investigate or resolve my complaint.<\/label><\/div>\n<\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_32_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\n\t<label for=\"field_name-1\" id=\"field_name-1_label\" class=\"frm_primary_label\">Name\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input  type=\"text\" id=\"field_name-1\" name=\"item_meta[32]\" value=\"\"  data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_33_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\n\t<label for=\"field_phone-1\" id=\"field_phone-1_label\" class=\"frm_primary_label\">Phone\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"tel\" id=\"field_phone-1\" name=\"item_meta[33]\" value=\"\"  data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_34_container\" class=\"frm_form_field form-field  frm_top_container\">\n\t<label for=\"field_address-1\" id=\"field_address-1_label\" class=\"frm_primary_label\">Address, City, State\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input  type=\"text\" id=\"field_address-1\" name=\"item_meta[34]\" value=\"\"  data-invmsg=\"Address, City, State is invalid\" aria-invalid=\"false\"   \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_35_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\n\t<label for=\"field_email-1\" id=\"field_email-1_label\" class=\"frm_primary_label\">Email Address\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"email\" id=\"field_email-1\" name=\"item_meta[35]\" value=\"\"  data-invmsg=\"Email Address is invalid\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_36_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\n\t<label for=\"field_date-2\" id=\"field_date-2_label\" class=\"frm_primary_label\">Date of Birth\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<input type=\"text\" id=\"field_date-2\" name=\"item_meta[36]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Date of Birth is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\n\t\n\t\n<\/div>\n<div id=\"frm_field_37_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit frm_flex\">\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\n\n\n\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_227_container\">\n\t\t\t<label for=\"field_58f1p\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_58f1p\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[227]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"X7VSrYqf3ggCo5\/ol\/GxtwYhSVvNo2jl7dXh9fE+3y7nUbsJzmE+LAGSLzWVM0wk\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"147\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>What is the complaint regarding? * Healthcare Fraud Fraud, waste or abuse by an HWC employee Whistleblower retaliation Grant\/Contract fraud Quality of Care Medical Identity theft OtherOther Program * Administration [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-6562","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/pages\/6562","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/comments?post=6562"}],"version-history":[{"count":16,"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/pages\/6562\/revisions"}],"predecessor-version":[{"id":8417,"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/pages\/6562\/revisions\/8417"}],"wp:attachment":[{"href":"https:\/\/healthwellnessok.com\/wp-json\/wp\/v2\/media?parent=6562"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}