Filing a Complaint with Medicare

In general, Medicare handles complaints pertaining to the quality and appropriateness of the care provided by the medical staff. This means preventable situations in which the hospital provided care which caused you harm or put you in a situation where harm was likely. Because the complaint process can vary depending upon your state of residence, you may wish to seek the assistance of your local ombudsman or other agency to help you in your complaint.

If you file a complaint with Medicare about the care that you receive in hospital setting, it may also be prudent to file a complaint with the hospital regulatory agency in your state. This is especially true if your complaint involves potential medical negligence, or other issues which may point to a widespread problem throughout the facility. And in both instances, it may be helpful to have the legal advice of an attorney who specializes in dealing with these types of issues.

Keep in mind that when your complaint is reviewed by Medicare, they will likely have an independent physician evaluate your medical records in order to establish whether or not you receive the type of care necessary throughout your hospital stay. Therefore, your own personal statements with regards to the type of care that you received and precisely what happened during the course of your hospital stay can prove invaluable with regards to proving your case, whether that case is in regards to the Medicare complaint, or more pressing legal action.

Regardless of the route you take with regards to filing your complaint, you want to have complete documentation of the process. Maintain copies of all of your records, and call into question anything which does not seem to be accurate at the time of review. It is not unheard of for some hospital staff to falsify records in an attempt to avoid legal action or professional sanction.