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Compliance
Violations of Communications and Marketing Guidelines
False Information on Enrollment Application The reporter witnessed that false information was given, oral or written, to one of our representatives during the process of obtaining medical coverage under one of the different medical plans offered by us. Also, if the reporter witnessed that the false information was provided by one of our representatives. For example, Signature forgery on our plan application or alteration of medical records.
False information Provided by Agents/Representatives An Agent/Representative of our plan provided information to the reporter that it was false or misleading in order to promote or sell one of our products. For example, Agent stated that a given Doctor is part of the CMS network, but it is not part of the network or that a given service is covered under the plan, but it turns out not to be covered.
Unauthorized Use and/or Distribution of Marketing Materials The reporter is aware or has received what he/she perceived to be a marketing material that it has not been authorized by the applicable regulatory agency (CMS, and any other Medicaid or state agency). For example, the reporter received a brochure from our plan that does not have the required approval numbers or and advertising material (TV, Radio or newspaper) that does not have the require approval numbers and/or disclaimers.
Unsolicited Contact by our Agents/Representatives At some point in time the reporter was approached or contacted by one of our Agent or Representative without his/her consent for marketing purposes. For example, unscheduled visit at home, unscheduled sales phone call, sales approach on the street without inquiring about any of our product, etc.