To submit a Compliance referral directly to Clever Care’s Compliance Team, fill out this form and provide as much detail as possible. If you wish to report anonymously, you do not have to provide your personal information. 

NOTE: No attempt will be made to discover the identity of someone making an anonymous report. However, be aware if a referral does not have sufficient information, we may not be able to take further action. 

If a Clever Care member is involved in the referral, please provide the member's information below.

If a provider is involved in this referral, please provide the provider's information below.

If any other party is involved in the referral, please provide the other party's information below.