Filing a Complaint

The Arkansas Foundation for Medical Care (AFMC) works to promote quality health care for people with Medicare.  We review services in response to quality of care concerns received from Medicare patients or their families.  The purpose of our review is to help doctors and health care providers improve the future care they give to Medicare patients.

If you have a complaint about the quality of health care that Medicare is paying for, write it down and send it to AFMC.  If the care is being billed to Medicare — whether it is in a hospital, hospital outpatient clinic, home health agency, hospice, skilled nursing facility, ambulatory surgery center or physician’s office — AFMC can help. Once AFMC gets your written complaint, a review case manager will contact you to explain the review process in detail. Your review case manager will stay in touch with you until the review is complete.

We conduct our review based on the information written in the medical record. The medical record often does not contain a record of conversations, telephone calls or professional behavior. Expectations of the review process when the complaint is first filed often determine the satisfaction with the end results. Please understand that AFMC conducts its review based on instructions received from the Centers for Medicare & Medicaid Services (CMS). There are limitations to our review process, and we just want you to understand what those limitations are from the beginning.  For instance, we cannot:

• interview anyone, including the physician or the provider's staff, by telephone or in person
• review environmental issues such as the cleanliness of the facility, the quality of the food or equipment problems
• review any payment issues.

If your complaint involves any of the issues mentioned above, we will refer that portion of your complaint to the appropriate state agency, with your permission.
 
If you have a quality of care concern, please print and complete the Medicare Beneficiary Complaint Review Request form and return it to the address below:

Thank you for your interest in the Medicare beneficiary complaint process.  Please contact us at 1-888-354-9100 if you have any questions or need help in filing a complaint OR you can fax your concern to:  479-649-0004.  For questions unrelated to quality of care issues, you may call 1-800-Medicare (633-4227).