Notification of Fraud, Willful Misrepresentation, or Abuse (FWA) Audit

Please submit this form for all audits conducted due to suspicion of FWA. Feel free to submit any questions regarding this process to PBMAudit@oag.ok.gov. Thank you.

Select or enter value
Caret IconCaret symbol

Who can OAG representatives contact for information regarding this notification?

Phone

What is the name of the pharmacy subject to the audit?

NCPDP ID number for subject pharmacy

Range of dates of Service

Please upload a full list of the claims/prescriptions included in the review. A template is provided on the website.


The list of claims should include the prescription number, BIN, Group ID, PCN, Fill Date, Paid Amount, NDC, Label Name, Network Reimbursement ID, and Plan name for each claim reviewed.

Drag and drop files here or