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NMCP Fraud, Waste and Abuse Mismanagement

HOTLINE COMPLAINT FORM

The BUMED Hotline Program was designed to strengthen and focus efforts to combat fraud, waste and mismanagement by providing an alternative method to the normal chain of command when it has been unresponsive or the complainant fears reprisal resulting from the submission of his or her allegations.

It is Navy Medicine's policy to demand and enforce the highest ethical standards from its members, fairly and efficiently manage its resources and people, and exercise a fiduciary responsibility over the taxpayers' dollars. The use of the Hotline Program is encouraged to identify problems in these areas so they can be swiftly corrected.

You may fill in all of the requested information, print this form, and FAX it to the NMCP IG at (757) 953-5799, or submit it electronically by clicking on the submit button at the bottom of the form.  

If you have not already done so, review the 4-Step Hotline Complaint Process before you fill out the form....

Step 1: Determine the best method to address your issue.
Step 2: Review the Frequently Asked Questions (FAQS) so that you will know what to expect when you file a hotline complaint.
Step 3: 

Prepare your complaint for submission to an IG.  (Information the IG will ask you to provide when you file a complaint.)
Step 4: File a complaint with an IG.

If you have any problems with this form, just email your complaint to
Benjamin.Liam@med.navy.mil or Dennis.Marion@med.navy.mil
If you don't have information for a particular field, enter "unknown".

1. Do you wish to remain anonymous?     Yes     No     (If yes, do not identify yourself below.)
 

2. If no, do you want confidentiality?     Yes     No     (If yes, identify yourself below. We will not release your name without your consent.)
First Name:
 Last Name:
Street Address:
City:
 State: Zip:
Country:
Home Phone:
Work Phone:
Email:
3. Are you willing to be interviewed?     Yes     No    
 
4. Who is involved?     (Include everyone's first and last names, rank/paygrade, and duty station/place of employment.)
Subject(s): Who performed the wrongdoing?
Witness(es): Who are the witnesses?
5. What did the subject do or fail to do that was wrong?
6. What rule, regulation or law do you think the subject(s) violated?
7. When did the incident occur?     (Provide dates and times i.e. "early 2008," etc...)
8. Where did the incident take place?     ( What location, command, etc...?)
9. Why do you think the incident took place?
10. How have you tried to resolve the problem?     ( Have you contacted your chain of command? Have you contacted your local Inspector General? Have you tried to resolve your complaint using an established process such as Bureau of Naval Records, Informal Resolution System, EO/EEO or legal system?)
11. What do you want the IG to do?
12. Additional information your wish to provide.

This statement is issued by me and I swear that it is the truth. I am aware that under the provisions of Section 1001, Title 18, United States Code, whoever knowingly and willingly falsifies, conceals, or covers up by trick, scheme or device, a material fact, or makes any false, fictitious or fraudulent statement or representation, shall be fined not more than $10,000 or imprisoned for not more than 5 years or both. Additionally, any person who willfully, and contrary to his/her oath, testifies falsely while under oath may be punished for perjury in accordance with Section 1621, Title 18, United States Code.

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Last Updated: 03-Apr-2012

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