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Quality of Care Complaints

MPRO wants to ensure that every doctor, facility and agency provide Medicare patients with high quality medical care. MPRO can review your concerns regarding care provided by your doctor or one of these facilities. You have a right to quality medical care. MPRO wants to know when you are dissatisfied with the quality of the medical care you receive.

If you do not think you received good care, you can request a free review of your care. There are specific instructions on how to file a complaint about the quality of care you received.

MPRO’s Review

Once MPRO receives your complaint, a Review Case Manager will be assigned who will be responsible for your case throughout the review process. MPRO will keep you updated on a regular basis. As reviews are based on the documentation in the medical record, a copy of your medical record will be requested from the health care facility. A doctor will perform an independent review. You will be notified when the review is complete. The review process can be lengthy, up to 165 days (4-5 months).

What We Look For:

MPRO physician reviewers look at medical records of Medicare patients and review issues such as whether:

• the services you were provided met professionally recognized standards of quality

• all necessary health care services were made available to you

• services were provided in a timely manner

• services were provided in an appropriate setting

• you were medically stable at time of discharge from the hospital

If MPRO finds a problem with the care you received, we will talk to the facility and/or doctor to recommend ways to handle the same situation in the future. This helps to improve the healthcare provided by the doctor or facility.