For nursing home care ONLY (not hospital care), every jurisdiction has an ombudsman who can intervene on your behalf to try to cure any complaint about quality of care. You can get a list of ombudsman for your jurisdiction by clicking here and scrolling to your state. This link goes to the Consumer Voice (formerly NCCNHR), a consumer advocacy group for quality long-term care.
For both nursing home and hospital care: If the patient with the quality of care issue is on Medicare, you can get the Medicare QIO (Quality Improvement Organization) to do an investigation. A Medicare beneficiary, or someone acting on the beneficiary’s behalf, must file a written complaint. The subject of the complaint has to concern “the quality of services … not meeting professionally recognized standards of health care.” (The statute is 42 U.S.C. § 1320c-3(a)(14).)
Thanks to a lawsuit brought against the federal government by Public Citizen, you have a right to learn the results of any investigation done by a QIO. The Court of Appeals for the D.C. Circuit ruled that: “At a minimum, this means that the [QIO] must disclose its determination as to whether the quality of the services that the recipient received met ‘professionally recognized standards of health care.’” Public Citizen, Inc. v. Department of Health and Human Services, 332 F.3d 654 (D.C. Cir. 2003).
If you are in Maryland, Virginia or the District of Columbia, your complaints all go to the same place, a Medicare contractor called KePro. Here is KePro’s website page which discusses how to make quality of care complaints: https://www.keproqio.com/bene/qualityofcarecomp.aspx. This page gives examples of poor quality care and informs Medicare beneficiaries that KePro can help prepare a written complaint and act as translator for beneficiaries who don’t speak English.
Here is the KePro “helpline” for D.C., Maryland and Virginia residents:
Here is the official information from the federal Medicare agency – which is called CMS, for Center for Medicare and Medicaid Services – on filling out and filing a quality of care complaint. https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms10287.pdf
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