Hello, this is Jennifer Smith.
Thank you for calling the health department.
(Pause)
Yes, that's correct, I can assist you with
filing a health care complaint.
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Yes, sir. I'll need some information from you
about what happened and who was
involved to complete this process.
Do you have time to discuss this with me?
(Pause)
Great. Let's get started,
what is your first and last name?
Throughout this video we will use the term
health care provider or provider
to refer to any facility, clinic, agency,
or other organization that provides
health care services.
Providers include hospitals, hospices,
outpatient centers, community mental health centers,
home health agencies, and many others.
In this video we'll review two ways
to file a health care complaint,
either with your state health department
or with a CMS health care
oversight organization, called the
Beneficiary & Family Centered Care-Quality
Improvement Organization, or BFCC-QIO.
You can file a health care complaint if you,
a friend, or a loved one receives poor-quality health care
or is treated badly by any type of health care provider.
Filing a complaint with your state health department or with
a CMS health care oversight organization
allows the government to investigate the issue and, if necessary,
allows the state health department to provide additional oversight and intervention.
Before filing a complaint, you should try to resolve the issues
with the health care provider directly.
This may involve talking with the provider's staff, management, or administrators.
If you are unhappy with the provider's response or
uncomfortable talking to the provider directly,
then you can contact your state health department or the CMS
BFCC-QIO that covers where you live.
On the left side of your screen, select the word Resources to
identify the complaint number
for your State Health Department, contact information for the CMS BFCC-QIOs,
Medicare resources pertaining to patients' rights, and information about advocacy.
Everyone has rights and protections under the law when receiving health care.
For example, you or someone you are representing
have a right to receive high-quality care
without abuse, neglect, or mistreatment.
You also have the right to
confidentially file a complaint if you feel you, a loved one, or a friend
has been mistreated, abused, neglected, or given poor-quality care.
On the left side of your screen, select the word Resources
to learn more about these rights and protections.
There are two broad categories of complaints:
improper care or unsafe conditions,
and quality of care.
Let's look at what each of these categories mean.
Improper care includes abuse or neglect
when care was provided in such a way
that could or
An example of this would be if a provider failed
to ensure protection from complications
that could have been prevented.
An example of unsafe conditions would be if you see water
damage or fire safety concerns in a facility
operated by your health care provider.
Abuse
injury, unreasonable confinement, intimidation,
or punishment that resulted in physical harm, pain,
or mental anguish.
Neglect
medical supplies, medical care, or proper food and nutrition
that were necessary to avoid physical harm or mental anguish.
Abuse can take many forms. For example:
Verbal abuse
and derogatory terms in oral, written,
or gestured language about someone receiving
health care or about other people close to the
person receiving care.
Such disparaging or derogatory language
would be considered verbal abuse
regardless of the age, ability to comprehend,
or disability of the person being spoken about.
Mental abuse
harassment, and threats of punishment or deprivation.
Sexual abuse
sexual harassment, sexual coercion, or sexual assault.
Physical abuse
slapping, pinching, and kicking.
It also includes controlling behavior through
corporal punishment that is,
inflicting harm as punishment.
The other category we mentioned before is complaints about
quality
Quality of care issues can be harder to define,
but here are a few examples:
Prescription errors
wrong prescriptions or giving you prescriptions that
interact in a negative way.
Unnecessary or inappropriate surgery
operating on you for a condition that could have been treated
effectively with prescriptions or physical therapy.
Unnecessary or inappropriate treatment
provider giving you the wrong treatment
or treatment you didn't need.
Not receiving an initial assessment
is critical for treating immediate care needs.
Not getting treatment after a change in your condition
your provider not providing treatment after abnormal test results
or after you developed a complication.
To file a complaint, you do not have to be the person affected
by the mistreatment, abuse, neglect, or poor care.
A family member, friend, caregiver, or representative
may file a complaint on behalf of another person.
One of the two options for filing a complaint is to contact
your state health department.
Health departments track the quality
and safety of the health care given by providers located throughout their states
to make sure providers comply with state and Federal regulations.
Part of that process includes investigating complaints
of possible noncompliance.
You can call your state health department to file complaints or grievances
about improper care, unsafe conditions, or poor quality of care.
You can contact your state health department by calling the general information number.
On the left side of your screen, select the word Resources to
display a list of several resources mentioned in this
including phone numbers and websites for each state's health department.
If it's not clear from the telephone prompts how to make a complaint,
follow the prompts to speak to a staff member for assistance.
If you have concerns of privacy,
remember that you have the right to make the call anonymously.
When you file a complaint, you will need to provide
information about the incident that caused your complaint,
including the names of those who were affected
and the name and address of the provider.
Your state health department will ask you to explain
what happened, what you think about it, the resolution
you're looking for if applicable
and whether you've contacted other agencies or people for help.
If you are concerned about privacy or have other reasons
for not providing your name,
you have the right to file a complaint anonymously.
After you file a complaint with your state health department,
the complaint will be reviewed by the agency
and then investigated in accordance with state and Federal laws
to determine if the provider violated any regulations.
If your complaint is about poor quality of care given to a
person who receives Medicare,
the second option for filing a complaint is to do so by filing a complaint
through a CMS BFCC-QIO, which you learned about in the Right
to File a Complaint section of this video.
Online resources can direct you to the one serving your area.
The relevant CMS BFCC-QIO can help you resolve a Medicare complaint
by starting a conversation between you and your provider
using an informal process called Immediate Advocacy.
On the left side of your screen, select the word Resources
to learn more about CMS BFCC-QIOs and about Immediate Advocacy.
You should also contact your CMS BFCC-QIO
if you feel you were discharged
from a hospital too soon or if you were discharged with
incomplete instructions or arrangements.
An example of being discharged
too soon is being sent home
while still in severe pain.
An example of being discharged with
incomplete instructions or arrangements
is being sent home without directions
for changes in your daily medicine.
You can also use the Medicare.gov
website to learn more or to access additional resources.
On the left side of your screen, select the word Resources to display
a list of several resources mentioned in this video,
including phone numbers and websites for each state's health
department, which you can use to
contact your state health department.
The Resources also include links
to pages on the Medicare.gov website
that can help you navigate this process.
Thank you, Mr. Scott. I have everything
I need to begin the investigation process.
Please keep the complaint reference
number and contact information
provided today in a safe place in case
you need to call back to follow up.
(Pause)
Yes, if we need additional information,
I will reach out. Have a nice day.