Anonymous Reporting Tool

This tool allows you to report anonymously or to provide your contact information.

Report

1. ACO Name:(Required)

Select the ACO.

2. What is your relationship to the organization?

3. Is your report about a provider?

Yes

Provider's Name:

4. Where are you located?

5. Please provide the details of your concern.

6. Where did this happen?

7. When did this happen?

8. Do you want to leave your name and/or contact information? Please remember that this is completely optional.

If you wish to remain anonymous, the investigation may be limited to the information you have provided here.

Yes

Your Name & Contact Information:

Name

This field is for validation purposes and should be left unchanged.

This Anonymous Reporting Tool is operated by Wilems Resource Group, an independent company, and has been provided to give you an opportunity to report any compliance concerns regarding an Accountable Care Organization (ACO) or organizational activities. This tool allows you to report anonymously or to provide your contact information. Rest assured, if you decide to remain anonymous, no one will know that you have made a report.

The information you submit will be transmitted to the organization’s Compliance Officer, and it will be up to the organization to follow-up on the report. The organization has a non-retaliation policy. This means that you do not need to fear making a report in good faith.

ACOs rely on individuals like you to let them know when something is wrong. If you are a patient, or a family member of a patient, your or your family member’s medical care will not be negatively impacted as a result of the report. If you feel that you are being retaliated against, please call the Compliance Officer.