How to File a Quality of Care Complaint

Filing A Complaint

Do you or someone you know have Medicare?

Are you unhappy with the medical care you had from a healthcare provider, such as a hospital or skilled nursing facility?

If you said “yes,” you can call Acentra Health and one of our staff will talk with you about filing a quality of care complaint. Our phone numbers are below.

Reasons Why You May Choose to File A Complaint

You may want to call Acentra Health if you (or the person you are calling for):

• Received the wrong medicine
• Received too much of a medicine dose (i.e., overdose)
• Received a surgery or medical test that you didn't need
• Received a wrong diagnosis (the doctor didn't figure out what was wrong with you)
• Received discharge instructions that weren't complete
• Your condition changed, but it was not treated

Quality of Care Complaint Example

A Medicare patient has dementia and is using a wheelchair after being in the hospital with pneumonia. She is very weak and is taking medicines that affect her walking and standing. The staff at the skilled nursing facility said she fell over in her wheelchair and hit her head. Her husband thinks they should have had someone watching her or done something to prevent her fall, but they didn’t seem concerned.

He contacted Acentra Health and asked for a medical record review to see if his wife received the appropriate care.

Completing the Quality of Care Complaint Form

Acentra Health can help you write out and file a formal complaint. The complaint form will then be sent to you to sign. Once Acentra Health receives the written complaint back from you, the quality of care review will begin.

If you don’t want to call Acentra Health, you can get the quality of care complaint form to complete and fax, mail, or email to Acentra Health.

Get the form:

• Quality of Care Complaint Form (PDF)
• Quality of Care Complaint Form - Spanish Version (PDF)

Send the completed form to Acentra Health:

• To mail, send to:
  Acentra Health
  1650 Summit Lake Dr., Suite 102
  Tallahassee, FL 32317
• To email, send to: beneficiary.complaints@acentra.com
  How to email the completed form: Emailing the Completed Quality of Care Complaint Form (PDF)
  Please note that while returning the completed form by email is an option, Acentra Health is not responsible for the privacy of the beneficiary’s private health information and that doing so may not offer enough security for protected health information.
• To fax, send to: 1-844-266-3208
  Faxing is the least preferred method of sending the completed form. Please mail (US Postal Service) or email, if possible.

Get details about the process and what to expect when a complaint is filed:

• Quality of Care Review Process Guide - English Version (PDF)
• Quality of Care Review Process Guide - Spanish Version (PDF)

To request a copy of medical records, please follow this process: Medical Record Request (PDF).

Appoint a Representative

Any person you choose, such as a family member or friend, may help you file a quality of care concern.

You must first fill out this form: Appoint a Representative form (Form Number 1696).

If you have questions about appointing a representative, call 1-800-MEDICARE (633-4227). TTY users should call 877-486-2048.

If you're on Medicare, you can call 1-800-MEDICARE if you:

• Have general questions about Medicare coverage;
• Need clarification on how to enroll in Medicare; or
• Want to discuss billing issues.