myPlace Health

Contact us at: (833) 883-2889 | TTY 711

Compliance and Regulatory

CMS Appointment of Representative
Form (CMS Form-1696)

Compliance Reporting and Hotline

myPlace Health is committed to detecting, correcting, and preventing fraud, waste, and abuse. Suspected fraud, waste, or abuse should be reported to myPlace Health by either:

1. Filling out the form below

2. Emailing us directly at

3. Calling our CA Compliance Hotline at (213) 800-8886

Anonymous Reporting - Your Information is Confidential

You are not required to provide us your name or contact information. However, if you do, we’ll keep it confidential. You can also choose to provide your contact information and not your name.


Covered Individuals who, in good faith, report a possible violation of law, regulation, policy, procedure or the Code will not be subjected to retaliation, retribution or harassment in accordance with the myPlace PACE Non-Retribution/Non-Retaliation policy. No Covered Individual at any level is permitted to engage in unlawful retaliation, retribution or any form of unlawful harassment against any other Covered Individual for reporting such a concern in good faith. Anyone who conducts or condones such retribution, retaliation or harassment in any way will be subject to discipline, up to and including discharge.

Please include the “Who, What, When, Where, How and Why” of the issue and attach any relevant supporting documents below.

You don't need to give us your name or contact information. But if you do, we'll keep it confidential.

*By submitting this information, I verify that I am providing my own contact information and I authorize myPlace Health to contact me.