Medicare beneficiary complaints about quality of care

This study examined all Medicare beneficiary complaints about quality of care submitted to the California Peer Review Organization (PRO) over 18 months. The complaint rate was low, and a medical record review by the PRO only confirmed 13% of the complaints. Managed Care Organization (MCO) members filed significantly more complaints about denial and/or delays in receiving services and the failure to refer to specialists. Fee-for-service complaints focused on inpatient hospital services, particularly premature discharge, discharge planning, admission necessity, and unnecessary tests. The PRO review process took over 7 months, and the findings were generally not released to the complainants.