How do I file a complaint about the quality of my care?

Contact your Quality Improvement Organization (QIO) for complaints about the quality of care you got from a Medicare provider.

Quality of care complaints could include:

Like being given the wrong drug or being given drugs that interact in a negative way.

Like being operated on for a condition that could’ve been effectively treated with drugs or physical therapy.

Like being given the wrong treatment or treatment you didn’t need.

Like not getting treatment after abnormal test results or when you developed a complication.

Like being sent home when you’re still in severe pain.

Like being sent home from the hospital without instructions for the changes that were made in your daily medicine.

Use the Medicare Complaint Form or follow the instructions in your plan membership materials to submit a complaint about your Medicare health or prescription drug plan.

For example, you think the customer service hours for your plan should be different.    

For example, you don’t think there are enough specialists in the plan to meet your needs.

To file a complaint about improper care (like claims of abuse to a person in a nursing home) or unsafe conditions (like water damage or fire safety concerns) in a hospital, home health agency, hospice, or nursing home contact your State Survey Agency (usually part of your State’s department of health services).

To file a complaint about conditions at a hospital (like rooms being too hot or cold, cold food, or poor housekeeping) contact your State department of health services.

To file a complaint about your doctor (like unprofessional conduct, incompetent practice, or licensing questions) contact your State medical board.

If you have a complaint about the quality of care you’re getting from a home health agency, call the home health agency and ask to speak to the administrator. If you don’t believe your complaint has been resolved, call your state home health hotline. Your home health agency should give you this number when you start getting home health services.

Note

For questions about a specific service you got, look at your Medicare Summary Notice (MSN) or go to MyMedicare.gov. If you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan, you can file an appeal.