Medicare Beneficiary Complaint Response Program

As the Medicare Quality Improvement Organization (QIO), Oklahoma Foundation for Medical Quality (OFMQ) handles clinical quality of care complaints in Oklahoma. The Medicare Beneficiary Complaint Response Program offers two options for resolving a complaint:

Medical Record Review
Mediation

The Medicare Beneficiary Complaint Response Program:

Handles Medicare beneficiaries’ or their representatives’ complaints initiated in writing or by telephone

• Provides a case manager who works with the beneficiary from start to finish to keep the beneficiary informed throughout the review process about the status of their complaint
• Utilizes physician peer review to assess clinical quality of care issues in a patient’s record of care (referred to as Medical Record Review)
• Focuses on individual-based quality improvement efforts whereby a case can lead to systems level quality improvements in future care rendered

Typical cases OFMQ may review include those when the beneficiary:

• Received the wrong medication
• Underwent inappropriate surgery
• Received erroneous dose of medication
• Experienced an error in treatment
• Received inadequate care or treatment by any healthcare professional
• Was discharged too soon
• Change in the condition was not treated
• Received inadequate discharge instructions

For more information, see the CMS website