Start the complaint process in your state to document your concern and help other beneficiaries avoid the problems you have been troubled with. Check Medicare.gov for more on the agencies that handle specific filings.
File a Complaint with Your State Medical Board
You can file complaints about a Medicare provider for unprofessional conduct and incompetent practice with your state medical board. Each state may have a slightly varying complaint process, but often you will file a complaint by phone or through mail, fax, or email.
When you file your complaint, you must disclose specifics so the board can follow up and investigate the matter. Prepare to share the names of people involved and describe the incident, including where and when this happened and which employees were involved. The board will want to know how you were harmed or could have potentially been harmed, along with the facility’s response in addressing your complaint.
You, your family member, or a caregiver can file a complaint against the Medicare provider. The board does not share your name with the facility, but they will ask for contact information if you want to be updated on the outcome of the investigation. It may take weeks to months for your complaint to be investigated.
Quality of Care Complaints
Why might you have a problem requiring Medicare’s attention? Some common complaints come from troubles with the quality of care received from a provider or facility. These can include drug errors from receiving the wrong drug or drugs that interact poorly. You may be given inappropriate or unnecessary treatment or surgery that could have been handled with other therapeutic measures. Some quality of care concerns come from beneficiaries who do not get treatment after a complication or new condition arises or after concerning lab results.
Another cause for concern is when you are discharged before you are medically ready or discharged without care instructions. If you are concerned about being discharged too soon, speak to the discharge planner, who can communicate with the doctor or other providers about your care.
For Complaints about a Hospital or Facility
Sometimes, it isn’t one provider for who you take fault with. If you have a problem with the hospital conditions, you can contact your state department of health services. For complaints about poor medical care, you can speak with your doctor and nurses, then file a complaint with your state Quality Improvement Organization or the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), which handles Medicare complaints involving quality of care.
Get Help with Your Medicare Rights
Knowing who to contact when you have a problem is tricky when there are so many lettered organization names. Visit the Medicare website to learn more about the different agencies handling beneficiary concerns, or call 1-800-MEDICARE for additional guidance.
The team at Magellan Healthcare is also here to help. Speak with our Medicare agents for assistance with your Medicare coverage needs.
