For Professionals: Medicare billing, claims and appeals

Medicare Beneficiary Complaint Chart

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Published: June 2007

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.

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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.

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