This information sheet describes different ways a person can file a complaint against an individual health care provider or a health care facility. The publication is separated into three categories: general information about filing a complaint, detailed information about the complaint processes of various agencies, and referral information for personal injury or medical malpractice attorneys.
I. General Information About Filing A Complaint
Why should a person file a complaint against a health care provider or facility?
If a person feels that a health care provider or facility mistreated him or her, a person may file a complaint. By filing a complaint, the provider or facility may be forced to stop its harmful actions, stop unethical or ineffective treatment, or improve the overall quality of care.
Where can a person file a complaint?
A problem often can be resolved by filing a complaint with the health care facility or agency. However, if the facility or agency does not adequately or effectively respond to the complaint, a person may file a complaint with a number of other organizations depending on whom the complaint is against and what the complaint is about. A person may file complaints with more than one organization.
Below are some options for filing complaints against health care providers, health care agencies or organizations, or hospitals and other health care facilities:
What is the complaint about?
A health professional regulated by the Washington State Department of Health, such as: a doctor, doctor’s assistant, nurse, nurse’s assistant, pharmacist, psychologist, mental health counselor, occupational therapist, or a facility or agency licensed by the Department of Health, such as: hospitals, surgery centers, home health or hospice agencies, clinics, labs, psychiatric facilities and state schools for hearing and visually impaired.
Where is the complaint filed? Washington State Department of Health, Health Systems Quality Assurance Division.
What is the complaint about?
A health care organization or program that The Joint Commission accredits or certifies, including hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services.
Where is the complaint filed? The Joint Commission’s Office of Quality Monitoring.
What is the complaint about?
Discrimination on the basis of race, color, national origin, disability, age, sex, or religion by entities receiving federal financial assistance from the U.S. Department of Health and Human Services; violation of rights under the federal health care provider conscience protection statutes; or violation of the HIPAA Privacy Rule, HIPAA Security Rule, or the confidentiality provisions of the Patient Safety Rule.
Where is the complaint filed? U.S. Department of Health and Human Services Office for Civil Rights.
What is the complaint about?
The quality or necessity of care for a Medicare beneficiary.
Where is the complaint filed? Livanta, the Beneficiary and Family-Centered Care Quality Insurance Organization for Washington State.
II. Specific Information About How To File A Complaint
This section provides information about how to file complaints with the agencies listed in the chart above, as well as information about what each agency may do in response to the complaints.
1. Washington State Department of Health, Health Systems Quality Assurance (HSQA) Division
Who can file a complaint?
Anyone who has knowledge of a health care provider’s actions or has knowledge about an incident or event occurring in a facility licensed by the Department of Health may file a complaint.
About what?
A complaint filed with HSQA against a health care professional may concern (1) the provider’s ability to practice with reasonable skill and safety, (2) unprofessional conduct, or (3) unlicensed practice. Health care professionals include, but are not limited to, doctors, doctor’s assistants, nurses, nurse’s assistants, pharmacists, psychologists, mental health counselors, and occupational therapists.
A complaint filed with HSQA against a health care facility may concern a violation of state licensing laws and in some cases federal Medicare rules. Health care facilities include ambulatory surgery centers, child birth centers, child group care homes, home care agencies, home health agencies, hospice agencies, hospice care centers, hospitals, clinical laboratories-medical test sites, Department of Corrections prisons, residential treatment facilities, rural health clinics, Eastern/Western State Hospitals, and State Schools for Hearing and Visually Impaired.
Complaint form
To file a complaint against a health care provider or facility, an individual can fill out the HSQA complaint form available online. The form can be mailed to:
Washington State Department of Health
Health Systems Quality Assurance
Complaint Intake
PO Box 47857
Olympia, WA 98504-7857
The complaint also can be emailed to HSQAComplaintIntake@doh.wa.gov or faxed to (360) 236-2626.
For questions or to file a complaint over the phone, a person can call (360) 236-4700. For more information, go to HSQA’s website.
Scope of investigation
After a complaint is filed, HSQA conducts an initial assessment to determine whether the agency will investigate the complaint. If the complaint asserts a violation of a law or rule and HSQA has authority to investigate the health care provider or facility, then HSQA will investigate.
After completing the initial assessment, HSQA will notify the person who filed the complaint as to whether or not HSQA will conduct an investigation. Investigations generally take about 170 days to complete. HSQA may ask a person who filed a complaint for more information or to testify if there is a hearing.
If the investigation concerns a health care provider, HSQA manages the investigation throughout the disciplinary process and works with investigators, staff attorneys, and the Office of the Attorney General to identify violations and evaluate the evidence. If the investigation concerns a health care facility, the investigation may include visiting the facility, reviewing patient records, reading and reviewing the facility’s policies, procedures, and documents relating to the incident, interviewing staff, and observing staff delivering care. If evidence does not support the complaint, the case will be closed.
Remedies available
If a violation is found against a health care provider, the case is presented to a panel of members from the department, board, or commission for approval to take action. Disciplinary action against health care providers includes, but is not limited to, fines, counseling, retraining, practice limitations, or suspension from practice.
If the complaint is against a facility, HSQA will send the complainant a letter explaining the findings and any actions taken to resolve the violations. HSQA may take corrective action against a health care facility in violation of a law or rule, but will not impose criminal or civil penalties against the facility.
Statute of limitations
HSQA has no time limitation in which individuals must file a complaint, but it is best to file the complaint as soon as possible so it is easier for HSQA to investigate.
2. The Joint Commission’s Office of Quality Monitoring
Who can file a complaint?
Anyone with a complaint about a health care organization accredited or verified by The Joint Commission may file a complaint. The Joint Commission accredits various kinds of health care organizations, including hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities, and providers of home care services. The Joint Commission also provides certification to accredited organizations for programs devoted to chronic diseases and conditions, such as asthma, diabetes, and heart failure, and to providers of health care staffing services.
About what?
People can file complaints about the quality and safety of health care services. The Joint Commission does not address billing or payment disputes.
Complaint form
A person can file a complaint against a health care organization accredited or certified by The Joint Commission by filling out the complaint form on The Joint Commission website. A person also can file a complaint by summarizing the issue in two pages or less and including the name and address of the organization in question.
A complaint can be mailed to:
Office of Quality Monitoring
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
For questions regarding filing a complaint with The Joint Commission, call (800) 994-6610. For more information, see The Joint Commission’s website.
Scope of investigation
The Joint Commission determines whether the complaint relates to one or more Joint Commission standards for accreditation or certification. The Joint Commission standards are not available on its website, but can be purchased online.
The Joint Commission may use the information provided in the complaint to identify noncompliance with the organization’s accreditation or certification. In assessing this compliance, The Joint Commission may:
- conduct an unannounced or unscheduled onsite evaluation of the organization;
- request that the organization provide a written response to the complaint; and/or
- review the organization’s accreditation or certification.
Remedies available
The specific details about The Joint Commission’s evaluation and follow-up are confidential. However, a complainant can make a written request to The Joint Commission to find out the following:
- whether the complaint was relevant to the organization’s compliance with accreditation or certification standards, and if so, the specific standards identified;
- the course of action The Joint Commission has taken or will take to evaluate compliance;
- the standards for which The Joint Commission issued a requirement for improvement following an on-site evaluation; or
- any change The Joint Commission made to the organization’s accreditation or certification.
Individuals also can check information about the organization by obtaining a Quality Report from The Joint Commission. An individual can request a report by calling (630) 792-5800 or by writing to:
Customer Service Center
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
3. U.S. Department of Health and Human Services (HHS) – Office for Civil Rights (OCR)
Who can file a complaint?
Any person can file a complaint with the U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) if the person believes that a health care or human services entity that OCR has jurisdiction over has violated a person’s civil rights. OCR has jurisdiction over entities such as state and local social and health services agencies, hospitals, clinics, nursing homes, or other entities receiving federal financial assistance from HHS.
About what?
Complaints filed with OCR may be about (1) discrimination on the basis of race, color, national origin, disability, age, sex, or religion; (2) violation of rights under the federal health care provider conscience protection statutes; or (3) violation of the HIPAA Privacy Rule, HIPAA Security Rule, or the confidentiality provisions of the Patient Safety Rule.
Complaint form
Complaint forms are available online from OCR. Once completed, they can be printed out and mailed or faxed to the OCR regional address where the alleged violation took place. The address and fax number for Washington State is:
Office for Civil Rights, DHHS
2201 Sixth Ave – Mail Stop RX-11
Seattle, WA 98121
Fax: (206) 615-2297
Complaints also may be sent by email to OCRComplaint@hhs.gov. For more information, see OCR’s website.
Scope of investigation
Once OCR receives a complaint, it will determine whether it has legal authority to review and investigate the complaint. OCR’s primary authority is over recipients of federal financial assistance from HHS.
If OCR has authority to investigate the complaint, the investigator will gather information by interviewing witnesses, obtaining documentation, and visiting appropriate sites. The person who filed the complaint may be interviewed.
After the investigation, OCR will issue a closure letter that states OCR’s decision as to whether there was a violation of a federal statute or regulation.
Remedies available
If OCR finds a violation of a federal statute or regulation, OCR will try to resolve the case by obtaining a voluntary agreement with the entity. OCR will give the entity a specific time period to correct the violation or provide OCR with a plan of correction. If the entity does not resolve the case so that OCR is satisfied, OCR will issue a Letter of Findings that explains how the entity is not in compliance and identifies next steps. Such next steps may include:
- referral to the Department of Justice for enforcement action;
- steps to terminate federal financial assistance to the covered entity; or
- other actions.
Statute of limitations
Complaints must be filed within 180 days from the date of the alleged discriminatory act. OCR may extend the 180-day period upon a showing of good cause.
4. Livanta
Who can file a complaint?
Only Medicare beneficiaries, an authorized representative or a family member may file a complaint with Livanta.
About what?
Complaints may concern the quality of the care or other services provided by a Medicare provider. Some examples include situations in which care caused a patient harm or placed the patient in a situation where he or she could have been harmed such as the following: receiving the wrong medication, not receiving treatment for a hospital-acquired infection, receiving incomplete or no discharge instructions, or not receiving timely care.
Complaint form
To file a complaint, a person may contact Livanta at:
1 (877) 588-1123 or
1 (855) 887-6668 (TTY).
A person will need to complete a Medicare Quality of Care Complaint Form that can be found online. The completed form should be mailed to:
BFCC-QIO Program, Area 5
9090 Junction Dr., Ste 10
Annapolis Junction, MD 20701
The form can also be faxed to Livanta’s fax line: 1 (844) 420-6672. For more information, see Livanta’s website.
Scope of investigation
Once an individual contacts Livanta about a complaint of care, Livanta will decide if Immediate Advocacy or a thorough formal quality of care review process is appropriate. Immediate Advocacy is an informal process used to quickly resolve a verbal complaint. The Medicare beneficiary or a representative must verbally agree to Immediate Advocacy. Through this informal process, Livanta will immediately contact the provider to attempt to efficiently resolve the complaint. A Medicare beneficiary or the representative may discontinue Immediate Advocacy at any time.
If instead an individual makes a formal quality of care complaint, Livanta begins its review by requesting medical records and providing them to an independent doctor. This independent doctor will review the medical records, look at all aspects of the care received, and speak with the medical providers who provided the care. Based on the doctor’s findings, Livanta will decide how to address and resolve the complaint. Livanta will inform the Medicare beneficiary or representative whether the care met professionally recognized standards.
An individual can check the status of the quality of care review by visiting Livanta’s website, and clicking on “Check Case” and entering the case number.
Remedies available
If Livanta determines that the care an individual received did not meet the professionally-recognized standards of health care, Livanta can explore methods to resolve the complaint such as:
- Notifying the provider of the failure to meet the standards;
- Requiring the provider to take a class or obtain more training;
- Forwarding the concern to a Quality Innovation Network (QIN-QIO) that works with hospitals and doctors to help improve quality;
- Sending Livanta’s findings to the proper state agency; or
- Examining the medical records of other Medicare beneficiaries treated by the provider to determine if additional quality of care concerns exist.
III. Personal Injury Or Medical Malpractice Suits
A person who feels that he or she deserves money damages from a health care provider may wish to contact a lawyer who specializes in personal injury or medical malpractice. Filing a complaint with one of the organizations listed above in this publication may force the health care provider to stop its harmful behavior, but may not result in money damages.
A person may want to contact a local county bar association’s lawyer referral service to find personal injury or medical malpractice attorneys. Bar associations with lawyer referral services include:
- King County: (206) 267-7010
- Kitsap County: (360) 373-2426
- Lewis County: (360) 748-0430
- Tacoma-Pierce County: (253) 383-3432
- Snohomish County: (425) 388-3018
- Southwest Washington (Clark, Cowlitz, Skamania, Wahkiakum): (360) 695-0599
- Spokane County: go to the Spokane Bar Association website, and click on “Online Lawyer Referral.”
The following federal funding partners shared in the cost of producing this material: the Administration on Intellectual and Developmental Disabilities AIDD (1601WAPADD); the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration SAMHSA (16SMP05397); and the Rehabilitation Services Administration RSA (H240A140048). These contents are the sole responsibility of Disability Rights Washington and do not necessarily represent the official views of SAMHSA, AIDD or RSA.
This information is current as of January 2016.
This information is a service of Disability Rights Washington (DRW). It provides general information as a public service only, and is not legal advice. If you need legal advice, you should contact an attorney. You do not have an attorney-client relationship with DRW. If you would like more information about this topic or would like to receive this information in an alternative format call DRW at (800) 562-2702, or email info@dr-wa.org.
Always advocate in a timely manner. Please be aware that there are certain time limits or deadlines to file a complaint, a lawsuit, or take legal action.
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