As the federally designated Medicare Quality Improvement Organization (QIO) contractor for West Virginia, Pennsylvania and Delaware, WVMI & Quality Insights can review complaints about the quality of care you received in the following health care settings:

• Hospital emergency department
• Skilled nursing facility, also called a nursing home
• Rehabilitation facility
• Ambulatory surgery center
• Doctor's office
• Home health agency

Our review is free to you. Everyone with Medicare has this right, including those who are a member of a Medicare Advantage plan, such as an HMO. The first step to initiate a review in any state is to call 1-800-MEDICARE. The Medicare representative will put you into contact with us to review your case.

The Review Process

If you have a quality of care complaint while in a health care facility, our review will begin as soon as you call us.

If you have been released from the facility, you can call 1-800-MEDICARE to discuss your complaint and ask for a complaint form. Or you can have someone else make the call for you. The form asks for the following:

• Your name
• Your Medicare number
• The date you entered the facility
• The name of the facility that provided the care
• Your concerns

You can also give us a letter describing your complaint. We need your complaint in writing – a form or a letter to begin the review.

Once we get your complaint, we will ask the health care facility to send us a copy of your medical record. Then we will have a doctor review it. The review can take three to six months. We will notify you once we have finished.

Your Confidentiality

You may not want your doctor to know you have filed a complaint. If that’s the case, we can do the review without telling the doctor your name. In a confidential quality of care review, we will discuss our findings with your doctor. We will not tell the doctor your name, and we will not tell you the results. If you want to know the results of the review, you will have to allow us to tell the doctor you filed the complaint.

Our Findings

If we think there is a problem with your quality of care, we will talk to the facility or doctor to suggest ways to handle the same situation in the future. This helps the doctor or facility to improve care.

In rare cases, we may recommend that a facility or doctor be removed from the Medicare program. We only do this as a last resort after trying to work with the doctor or the health care facility to correct the problem. We do not want to punish doctors but to protect you and other people with Medicare by helping to improve the quality of health care all patients receive.

For more information, please call 1-800-MEDICARE.