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Each state has a Department of Public Health that works to ensure the health and safety of its residents. Clinicians are often legally required to report specific diseases, including some hospital infections, to their local (city) Department of Public Health which will accept the report, conduct an investigation, possibly complete laboratory testing and make recommendations to control an outbreak or improve patient safety. Many states now have medical error and hospital infection reporting laws which mandate the reporting of these events to state health departments where the numbers are evaluated and totaled. Patients can contact their state health departments using the link below to inquire about reporting adverse medical events and health care associated infections.
Many state health departments have a hospital licensing division that is responsible for ensuring health care facilities comply with state laws and regulations. Patients can register complaints with the hospital licensing division and trained personnel will conduct an investigation and issue a report. Patients should check with their state health departments for information on how to file complaints with the hospital licensing division.
Every Medicare beneficiary has the right to file a complaint, or to register a concern about their health care or health care provider. Patients and their advocates should realize that they have this right and know how to reach the entity that can take action on their complaints.
You can file a quality of care complaint if you have a concern about or are not satisfied with the quality of your care or treatment. Some common examples of quality of care complaints include:
Patients may register a complaint online if they are dissatisfied with a service, physician/provider, health care facility, insurance agent, and/or health care plan. People can also file insurance plan-specific complaints by phone at 1-800-MEDICARE.
If you are a CMS patient and any Medicare plan (including a drug plan) does not pay for a medical item or service, or if you are denied a service to which you feel you are entitled, you have the right to appeal. File an appeal at: http://www.medicare.gov/basics/appeals.asp.
If you suffer a medical error or have concerns about the quality of your hospital care, Medicare contracts with regional organizations called Quality Improvement Organizations (QIOs) with which you can file a complaint. Find your local state Quality Improvement Organization here: http://www.ahqa.org/pub/connections/162_694_2450.cfm.
The CMS Beneficiary Ombudsman website has information on these and other rights under the CMS programs. Visit http://www.cms.gov/center/ombudsman.asp or call 1-800-MEDICARE for assistance.
The Joint Commission – formerly called the Joint Commission on Accreditation of Health Care Organizations, or JCAHO—is a private, non-profit group that acts as a national accrediting organization for a great number of hospitals in the country. The Joint Commission reviews all quality of care complaints it receives but please note that it does not investigate issues associated with hospital bills or other financial issues.
The public can also submit a complaint to The Joint Commission via The Joint Commission's website: www.jointcommission.org. Scroll down to "Filing a Complaint.”
The Joint Commission also has a complaint telephone number at (800) 994-6610 where you can speak to a Joint Commission representative. However, no complaints are taken over the telephone.