Compliance, Ethics & Reporting Center

Report a Compliance Concern

You may report a concern involving Advantage Plus, an agent, employee, contractor, vendor, marketing activity, enrollment activity, privacy issue, consumer complaint, suspected misconduct, or potential violation of Medicare, insurance, carrier, privacy, or consumer protection rules.

Important Hotlines & Reporting Contacts

What You Can Report

This center may be used for a broad range of Medicare, insurance, privacy, agent conduct, carrier, and consumer protection concerns.

Medicare Complaints, Appeals & Grievances

Medicare complaints are generally used for concerns about quality of care, customer service, access to care, plan treatment, delays, or service issues. Appeals are generally used when there is a coverage or payment denial.

Fraud, Waste & Abuse Reporting

Fraud, waste, and abuse may include billing for services not provided, misusing Medicare information, offering improper incentives, falsifying applications, forging signatures, misrepresenting plan benefits, using deceptive marketing practices, or knowingly submitting false information.

Whistleblower Reporting

Whistleblower concerns may involve suspected fraud, false claims, kickbacks, retaliation, improper billing, falsified documents, privacy violations, unsafe practices, or misconduct involving Medicare, Medicaid, health plans, agents, vendors, contractors, or government programs.

Agent, Broker & Marketing Conduct Concerns

Report concerns involving misleading sales presentations, unauthorized plan changes, pressure tactics, inaccurate benefit explanations, inappropriate use of Medicare cards, unsolicited contact, missing Scope of Appointment documentation, or failure to follow CMS, carrier, or agency compliance requirements.

• Unauthorized Medicare Advantage, PDP, or Medigap enrollment.
• Misrepresentation of doctors, hospitals, drug coverage, premiums, or benefits.
• Improper gifts, inducements, rebates, cash offers, or misleading incentives.
• Misleading advertisements, mailers, social media posts, call scripts, or seminars.
• Failure to explain plan rules, networks, prior authorization, referrals, or prescription coverage.
• Failure to provide required disclosures, plan documents, or required enrollment information.
• Improper use of consumer data, Medicare cards, signatures, login credentials, or enrollment platforms.

Medicare Marketing Guidelines Resource Center

Medicare marketing must be truthful, not misleading, properly documented, and compliant with CMS, carrier, federal, state, and agency rules. Agents should only use approved materials when required and should never represent themselves as Medicare, CMS, Social Security, or a government agency.

Enrollment, Consent & Plan Misrepresentation

Enrollment concerns should be reported immediately when there is suspected unauthorized enrollment, signature misuse, inaccurate plan explanation, missing consumer permission, incorrect provider or drug information, or pressure to enroll.

• Applications must be authorized by the consumer or legal representative.
• Plan benefits, premiums, networks, drugs, pharmacies, and provider access must be explained accurately.
• Agents should not submit applications using inaccurate, incomplete, or misleading information.
• Consumers must understand the plan they are enrolling into and any known limitations.

HIPAA, Privacy & Data Security Complaints

Privacy concerns may include improper disclosure of protected health information, unsecured documents, mishandled Medicare cards, unauthorized sharing of consumer information, data breaches, or failure to safeguard sensitive information.

Unwanted Calls, Texts, Robocalls & Do Not Call Issues

Consumers may report unwanted calls, texts, spoofing, robocalls, telemarketing concerns, or suspected violations involving telephone, SMS, consent, or lead-generation activity.

State Department of Insurance Complaints

Insurance complaints may also be filed with the applicable state department of insurance, depending on the consumer’s state, product type, and issue.

California Health Plan Complaints

Some California health plan complaints may fall under the Department of Managed Health Care, depending on the plan type and issue.

Carrier Complaint & Compliance Resources

Consumers, agents, and agencies may also need to contact the applicable insurance carrier directly for plan-specific complaints, grievances, appeals, enrollment corrections, member service issues, broker conduct matters, or compliance escalations.

Senior Medicare Patrol & SHIP

Senior Medicare Patrol programs help Medicare beneficiaries, families, and caregivers detect, prevent, and report Medicare fraud, errors, and abuse. SHIP programs provide free local Medicare counseling.

Compliance Training Library

Agents should complete all required carrier, CMS, AHIP, agency, product, and annual compliance trainings. Training records should be retained where required and available for review upon request.

Documentation to Include

To help review a concern, include as much detail as possible:

• Date and time of the incident.
• Name of agent, agency, carrier, plan, consumer, or vendor involved.
• Phone numbers, emails, screenshots, call recordings, text messages, mailers, ads, or documents.
• Medicare plan name, carrier name, application ID, or member ID if applicable.
• Description of what happened and what outcome is requested.
• Whether the consumer already contacted Medicare, the carrier, CMS, HHS-OIG, OCR, DOI, FCC, FTC, SMP, or SHIP.

How Compliance Reports Are Reviewed

• Reports are logged and reviewed by the appropriate compliance contact.
• Urgent consumer, privacy, legal, regulatory, or carrier matters may be escalated immediately.
• Supporting documents may be requested when needed.
• Corrective action may include coaching, retraining, carrier escalation, disciplinary action, termination, or regulator/carrier reporting when appropriate.
• Some issues may need to be reported directly to Medicare, CMS, HHS-OIG, OCR, a carrier, law enforcement, or a state or federal regulator.

Non-Retaliation Policy

Advantage Plus prohibits retaliation against any person who reports a concern in good faith, cooperates with an investigation, refuses to participate in misconduct, or raises a compliance, privacy, consumer protection, employment, ethical, or legal concern.

Audit, Monitoring & Corrective Action Program

Compliance monitoring may include review of marketing materials, enrollment documentation, call recordings, consumer complaints, carrier notices, agent training records, lead sources, website disclosures, and corrective action follow-up.

• Periodic review of agent and agency compliance procedures.
• Documentation of complaints, corrective actions, and resolution steps.
• Escalation of serious matters to carriers, regulators, or legal counsel when appropriate.
• Ongoing agent education and updates when rules, carrier requirements, or agency policies change.

Record Retention & Evidence Preservation

Agents and staff should preserve documents, emails, call recordings, text messages, forms, screenshots, Scope of Appointment records, enrollment confirmations, carrier notices, and other records relevant to a compliance issue.

Consumer Rights Center

• Consumers have the right to accurate plan information.
• Consumers have the right to choose whether to enroll.
• Consumers have the right to file complaints and appeals.
• Consumers have the right to privacy and responsible handling of their information.
• Consumers have the right to contact Medicare, a carrier, SHIP, SMP, a state DOI, or another regulator directly.

Accessibility & ADA Support

If you need help accessing this page, submitting a report, or using any compliance resource, please contact us so we can provide reasonable assistance. Consumers may also contact Medicare, the health plan, or applicable government agencies directly.

AI Usage, Data Security & Vendor Compliance

Any technology, vendor, AI tool, CRM, call system, enrollment platform, lead vendor, marketing system, or data processor used in connection with Medicare or insurance activity should be reviewed for privacy, security, consent, accuracy, and compliance risks.

• Do not upload PHI or sensitive consumer information into unapproved tools.
• Do not use AI-generated marketing or sales content without compliance review when required.
• Vendors should follow applicable privacy, security, consumer consent, and carrier requirements.
• Report suspected vendor misuse of consumer information immediately.

Official Reporting Directory

Compliance Disclaimer

This Compliance, Ethics & Reporting Center is provided for informational and reporting purposes only. It does not replace Medicare, CMS, HHS-OIG, HHS OCR, a health plan, law enforcement, state regulators, legal counsel, or emergency services. Reporting internally does not prevent any person from reporting directly to Medicare, CMS, HHS-OIG, OCR, a carrier, law enforcement, or a state or federal regulator.