Types of complaints we investigate
For all facilities, we investigate concerns about:
- Quality of care.
- Patient/resident rights.
- Building and equipment safety.
- For acute and primary care facilities (ambulatory surgical centers, birth centers, community clinics, convalescent care centers, dialysis treatment clinics, hospitals, hospital units), we investigate if you're unable to get an itemized bill.
- For hospitals only, we investigate when you don't receive:
- Clear information on financial assistance and payment plan options.
- A discount on your charges if you're uninsured and low-income (specifically, at or below 2.5 times the Federal Poverty Level).
We don’t investigate incorrect billing unless it pertains to hospital patients who are low-income and uninsured (see above).
Anyone can file a complaint
- Anyone with knowledge or concerns about a health care entity can file a complaint, including family members, concerned citizens and health care professionals.
- We accept anonymous complaints.
- If you file a complaint, our investigators don't share your name with the health care entity unless you instruct us otherwise.
- In some cases, the health care entity may be able to figure out your identity because of the nature of the complaint.
- When filing anonymously, be sure to provide enough information to enable us to effectively investigate the complaint, since we can't contact you for further information.
- We review complaints and prioritize them based on actual or potential harm to patients or residents.
- We may conduct the investigation at the health care entity or off-site.
- For on-site investigations, we usually interview a sample of patients/residents, family members, and staff, and review the entity’s records.
- For off-site investigations, we typically review the entity’s records and often interview staff.
- Unless you filed the complaint anonymously, we'll call you about the investigation outcome and send you a written summary of the investigation.
Consequences for the health care entity
Our investigator may or may not be able to verify the complaint allegations, based on the evidence gathered.
If we can’t verify an allegation, that doesn't confirm a reported incident didn't occur. Instead, it means there was insufficient supporting evidence to verify it occurred.
If we find the health care entity isn't in compliance with statute or regulations, we cite deficient practice and the health care entity must correct the violation.