If you are a Medicare beneficiary or caring for someone who’s on Medicare, you may ask “Who do I call to report a quality of care concern?” Generally, Medicare beneficiaries can use two procedures-one at the federal level and the other at the state level to report quality of care concerns.
Under federal law, any health care practitioner or provider who receives Medicare or Medicaid funds must ensure that their services are “of a quality that meets professionally recognized standards of care.” As a Medicare beneficiary, you or your representative can call the Beneficiary and Family Care Center-Quality Improvement Organization (BFCC-QIO) for your State to complain when services given by physicians, physician assistants, interns, nurses, physical therapists, durable medical equipment providers, and others don’t measure up to your expectations.
The CT State licensing board is not tied directly to Medicare and, unlike the BFCC-QIO’s can sanction providers by restricting or revoking their licenses to practice. They have the authority to discipline licenses for unprofessional conduct.
Failure to meet accepted standards of care is one example of misconduct that’s subject to disciplinary action by a board. Other examples of unprofessional conduct includes: alcohol and substance abuse, sexual misconduct, neglect of a patient, prescribing drugs in excess without a legitimate reason.
CHOICES can help assess quality of care concerns and decide how to proceed. Sometimes it’s not clear if a concern should go to the BFCC-Q10, a licensing board or to someone who can handle customer service and billing concerns. CHOICES can help you sort it out.
Call CHOICES at 1-800-994-9422 to speak with a counselor in your area.
This information was provided by CareNetworkLink.org