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Reporting complaints against Medicare Certified Agents

CMS requires us to report a variety of data regarding our brokers and agents.  While we track and submit most data they require there is one type of data we need from you:  disciplinary actions and complaints involving agents working with Medicare beneficiaries.

 

"Complaints" includes complaints we receive through Medicare as well as complaints made directly to MVP or the Broker Agency.

 

Unacceptable action by the agent includes, but is not limited to:

  • Knowingly violating any Medicare regulations
  • Willful or negligent violation of HIPAA policies and procedures
  • Using forceful or coercive tactics to make a sale
  • Knowingly misrepresenting plan information to make a sale
  • Violation of federal and/or state laws
  • Discourteous, unethical or insubordinate conduct while representing MVP benefits
  • Committing a fraudulent act or breach of trust in any circumstance
  • Unauthorized release of confidential information

A complaint must always be investigated and, if the complaint is valid it could result in “disciplinary action” along a broad continuum, from manager-coaching, documented verbal warning, re-training, a documented corrective action plan, suspension, or termination of employment or contract.  You should use your existing investigation and disciplinary action process.

 

Any disciplinary action along this continuum must be reported to CMS. Please note that some items are reported by the NYS DOI and our reporting must match, for example a short term revocation (for example, 1-2 days) is among those which CMS will receive from us and NYS DOI. Note that disciplinary action refers to action taken by the NYSDOI, MVP or the Employer. You can find the CMS requirements on the Internet by clicking here.

 

Report a complaint.