Health facilities complaints

 
 
Information required
  • Who was involved.
  • What happened.
  • When it happened.
  • How it happened.
  • Where it happened.

Types of complaints we investigate

  • For all facilities, we investigate concerns about:
    • quality of care.
    • patient/resident rights.
    • building and equipment safety.
 
  • In addition, 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 are:
    • unable to get an itemized bill.
 
  • In addition, for hospitals only: we investigate when you do not receive:
    • clear information on financial assistance and payment plan options.
    • a discount on your charges if you are uninsured and low income (specifically, at or below 250% of the federal poverty level).
 

Types of complaints we don’t investigate

 

  • We do not 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. 
Filing anonymously
  • 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.
Investigation process
  • 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 patient/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.
Outcome
  • 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.