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Beneficiary Complaint Response Program

As specified in § 1154(a)(14) of the Social Security Act, the QIO must conduct a review of all written complaints about the quality of services covered by Medicare which do not meet professionally recognized standards of health care. The complaint must be filed with the QIO by a beneficiary or by their representative.

FMQAI offers various options available to resolve beneficiary complaints.

Beneficiary Protection:
File a Quality of Care Complaint

Quality-of-Care Concerns
If a Medicare beneficiary has a concern or is not satisfied with the quality of care received, he or she can call the FMQAI Florida Medicare Beneficiary Complaints Helpline at 800-844-0795.

Examples of Poor Quality Care:
  • Receiving the wrong medication
  • Receiving unnecessary surgery/diagnostic testing
  • Receiving an overdose of medication
  • Experiencing a delay in service
  • Receiving inadequate care or treatment by any Medicare hospital or doctor
  • Experiencing a change in condition that was not treated
  • Receiving a misdiagnosis
  • Receiving inadequate discharge instructions
One of FMQAI's trained team members will listen to the complaint and help the beneficiary decide what to do. One of a beneficiary's choices is to make a formal complaint. If the beneficiary decides to make a formal complaint, an FMQAI team member can help put it in writing. Once FMQAI receives the written complaint, the quality-of-care review will begin.

The case may be suitable for mediation, a new alternative to resolve concerns by talking directly with a beneficiary's doctor.
(Learn more)

How and When to Contact FMQAI
Trained team members are available Monday through Friday from 8:00 a.m. to 4:30 p.m. However, a beneficiary can leave a message at FMQAI's toll-free number, 800-844-0795, 24 hours a day, seven days a week. One of FMQAI's team members will assist with translation services if English is not the beneficiary's primary language.

A beneficiary can call FMQAI at 800-844-0795 if he or she:
  • Wishes to discuss the quality of care received.
  • Wants to file a formal quality-of-care complaint.
  • Needs help understanding Medicare rights.
A beneficiary can call 1-800-MEDICARE if he or she:
  • Has general questions about Medicare coverage.
  • Needs clarification on how to enroll in Medicare.
  • Wishes to discuss billing issues.
  • Wants to learn more about Medicare benefits and services.

Medicare Health Care Quality Complaint Form
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