How to File a Quality of Care Complaint
We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!
- Overview of Services
- How to File an Appeal
- Immediate Advocacy
- Appoint a Representative
- Additional Resources
- En Español
- Case Status Check
watch a video about
quality of care complaints:
To speak with a representative about Kepro's services, click on the link below for the phone number for your state.
filing a complaint
Do you or someone you know have Medicare?
Are you unhappy with the medical care you had from a healthcare provider, such as a hospital or skilled nursing facility?
If you said “yes,” you can call Kepro and one of our staff will talk with you about filing a quality of care complaint. Our phone numbers are below.
reasons why you may choose to file a complaint
You may want to call Kepro if you (or the person you are calling for)
- Received the wrong medicine
- Received too much of a medicine dose (i.e., overdose)
- Received a surgery or medical test that you did not need
- Received a wrong diagnosis (the doctor did not figure out what was wrong with you)
- Received discharge instructions that were not complete
- Your condition changed, but it was not treated
quality of care complaint example
A Medicare patient has dementia and is using a wheelchair after being in the hospital with pneumonia. She is very weak and is taking medicines that affect her walking and standing. The staff at the skilled nursing facility said she fell over in her wheelchair and hit her head. Her husband thinks they should have had someone watching her or done something to prevent her fall, but they didn’t seem concerned.
He contacted Kepro and asked for a medical record review to see if his wife received the appropriate care.
Kepro can help you write out and file a formal complaint. The complaint form will then be sent to you to sign. Once Kepro receives the written complaint back from you, the quality of care review will begin.
If you don’t want to call Kepro, you can get the quality of care complaint form to complete and fax or mail to Kepro.
The completed form can be emailed to email@example.com.
Please note that while returning the completed form by email is an option, Kepro is not responsible for the privacy of the beneficiary’s private health information and that doing so may not offer enough security for protected health information.
Get the form:
- Quality of Care Complaint Form - English (PDF)
- Quality of Care Complaint Form - Spanish Version (PDF)
Get details about the process and what to expect when a complaint is filed:
- Quality of Care Review Process Guide - English Version (PDF)
- Quality of Care Review Process Guide - Spanish Version (PDF)
To request a copy of medical records, please follow the process shown here: Medical Record Request (PDF).
appoint a representative
Any person you choose, such as a family member or friend, may help you file a quality of care concern.
You must first fill out this form: Appoint a Representative form (Form Number 1696).
If you have questions about appointing a representative, call 1-800-MEDICARE (633-4227). TTY users should call 877-486-2048.
If you're on Medicare, you can call 1-800-MEDICARE if you:
- Have general questions about Medicare coverage;
- Need clarification on how to enroll in Medicare; or
- Want to discuss billing issues.