File a Quality of Care Complaint

Medicare wants to make sure your care meets established standards and guidelines. Call us if you do not think you are getting good care, or if you did not get good care, from one of the following Mississippi health care providers:

• Hospital
• Hospital Emergency Department
• Skilled Nursing Facility, also called a Nursing Home
• Rehabilitation Facility
• Ambulatory Surgery Center
• Doctor's Office
• Home Health Agency
• Hospice 

We will conduct a free review. Everyone with Medicare has this right, including those who are a member of a Medicare Advantage plan, such as an HMO.

Your Responsibilities 

If you have a quality of care complaint while in a health care facility, our review will begin as soon as you call us.

If you have been released from the facility, you can call 1-800-MEDICARE to discuss your complaint, they will instruct you to call Information & Quality Healthcare (IQH) at 1-800-844-0600 and ask for a complaint form. Or you can have someone else make the call for you.

The form asks for the following: 

• Your Name
• Your Medicare Number
• The Date of Services
• The Name of the Provider/Pracitioner that Provided the Care
• Your Concerns 

You can also give us a letter describing your complaint. We need your complaint in writing – a complaint form or a letter to begin the review.

Once we get your complaint, we will ask the provider/practiotioner to send us a copy of your medical record. Then we will have a doctor review it. The review can take three to six months. We will notify you once we have finished.

Your Confidentiality  

You may not want your doctor to know you have filed a complaint. If that’s the case, we can do the review without telling the doctor your name. In a confidential quality of care review, we will discuss our findings with your doctor. We will not tell the doctor your name, and we will not tell you the results. If you want to know the results of the review, you will have to allow us to tell the doctor you filed the complaint about.

Our Findings  

If we determine there is a problem with your quality of care, we will talk to the facility or doctor to suggest ways to handle the same situation in the future. This helps the doctor or facility to improve care.

In rare cases, we may recommend that a provider/practitioner be removed from the Medicare program. We only do this as a last resort after trying to work with the doctor or the health care facility to correct the problem.. We do not want to punish doctors but to protect you and other people with Medicare by helping to improve the quality of health care all patients receive.

For more information, please call 1-800-MEDICARE.