Published by: Medicare Rights Center
If you have a concern about the quality of care received from a Medicare provider, your concern can be directed to the Beneficiary and Family-Centered Care-Quality Improvement Organization (BFCC-QIO) for your area. The BFCC-QIOs are made up of practicing doctors and other health care experts. Their role is to monitor and improve the care given to Medicare enrollees. BFCC-QIOs review complaints about the quality of care provided by physicians, hospitals, skilled nursing facilities, home health agencies, and ambulatory surgery centers.
Examples of situations about which you might wish to file a quality-of-care complaint include:
- A medication mistake
- Developing an infection during a stay in a facility
- Receiving the wrong care or treatment
- Running into barriers to receiving care
You can file a quality-of-care complaint by calling your QIO or submitting a written complaint. When the BFCC-QIO gets your complaint:
- They should call you to ask clarifying questions about your complaint and to get the contact information for your provider.
- A physician of matching specialty will review the medical record to determine whether the care provided met the medical standard of care, or whether the standard of care was not met.
- You and your doctor will be notified by phone and in writing when the review is over (the review process can take up to a few months).
Livanta and KEPRO are currently the two BFCC-QIOs that serve the entire country. To find out which BFCC-QIO serves your state or territory and how to contact them, visit www.qioprogram.org/locate-your-bfcc-qio or call 1-800-MEDICARE.
If you have a Medicare Advantage Plan, you can choose to make complaints about the quality of care you receive through your plan’s grievance process, through the BFCC-QIO, or both.
Your state may have other ways for you to file a complaint about a provider or facility You may be able to file a complaint through the consumer or patient protection sections within your state’s office of the Attorney General. You can also consider filing a complaint through the state licensing boards that oversee providers, for example, the Board of Medicine or the Nursing Board.