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)
- Contact SNF’s administration for information on their complaint process
- Contact your local Ombudsman Program; 800-231-4024
- Contact Department of Health Services – Licensing and Certification Division for Hospitals & Nursing Homes to file a complaint. 916-552-8700
- Contact California Advocates for Nursing Home Reform (CANHR) for assistance with complaint process; 800-474-1116. Their website has detailed information on the complaint process.
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
- Contact the pharmacy manager or corporate office
- Contact the California Board of Pharmacy to file a complaint. You can download the complaint form and mail it in, or fill it out online.
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.
