Health care benefit programs issued or administered by Capital BlueCross and/or its subsidiaries, Capital Advantage Insurance Company^®, Capital Advantage Assurance Company^® and Keystone Health Plan^® Central. Independent licensees of the BlueCross BlueShield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital BlueCross in its capacity as administrator of programs and provider relations for all companies.

Report suspected fraud

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Please provide information about the individual who is suspected of committing fraudulent activities
* Individual's Name		Notification Date
* Street Address

* City	* State	* Zip Code
* Summary of suspected fraud

Best way to contact you NOTE: This information is optional. You may choose to remain anonymous.
Name
Phone Number	Email Address


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