Medicare Beneficiary Complaint Chart

You may find this a useful guide to dealing with Medicare beneficiary complaints. Remember, you can also send a copy of your complaints to your California Assembly Member and Senator. Visit ww.leginfo.ca.gov/yourleg.html to identify the Assembly Member and Senator for your district.

Download a printable PDF of this chart

Physicians

  • Contact Lumetra, CA’s Quality Improvement Organization; 800-842-1602; www.lumetra.com
  • Contact the California Medical Board;
    800-633-2322; www.mbc.ca.gov

Hospital Care

  • Contact hospital’s ombudsman program
  • Contact Lumetra for quality of care complaints and/or early discharge appeal;
    800-842-1602; www.lumetra.com
  • Contact Department of Health Services – Licensing and Certification Division for Hospitals & Nursing Homes to file a complaint. 916-552-8700

Skilled Nursing Facility (SNF)

Home Health Care

  • Contact the home health agency’s administration for information on their complaint process
  • Call the Home Health Hotline (800-554-0354) to file a complaint with a local home health agency, a toll-free number established by the state licensing and certification district office
  • Contact Lumetra, CA’s Quality Improvement Organization; 800-842-1602; www.lumetra.com

Durable Medical Equipment & Billings and Claims

  • Call 1-800-Medicare

Pharmacists

Medicare Fraud

  • Contact California Health Advocates’ Senior Medicare Patrol (SMP) project. They’ll forward the complaint to the appropriate Medicare Integrity Unit. Tel: 714-560-0309; Fax: 714-560-0319
  • Can also call 1-800-Medicare to report complaints to respective Medicare Integrity Unit
  • Unresolved complaints can be reported to Office of Inspector General’s Medicare Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477)

Insurance Agents

  • File a complaint with the CA Dept. of Insurance. See their website section “File a Complaint.” CDI Consumer Hotline: 800-927-HELP (4357)
  • File a complaint with the MA plan and/or Medicare Part D plan
  • If it involves Part D, send a copy to the Medicare Drug Integrity Contractor (MEDIC) via California Health Advocates’ SMP project. MEDIC is keeping a record of these complaints to identify abuse trends. California Health Advocates’ SMP Tel: 714-560-0309 Fax: 714-560-0319
  • Send California Health Advocates a copy of your complaint for monitoring trends, and beneficiary advocacy. Email to California Health Advocates’ Staff Attorney, David Lipschutz
  • Contact your local Health Insurance Counseling & Advocacy Program (HICAP) a t 800-434-0222.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.