Professionals

Medicare Quality Concerns

Medicare beneficiaries have rights and protections, especially the right to quality health care. Connecticut beneficiaries who have a concern or are not satisfied with their care can file a complaint with Qualidigm. Examples of quality of care concerns include medication issues, unnecessary surgery/diagnostic testing and delay in service.

After a complaint is filed, a review team examines the care provided and makes an initial finding regarding whether standard guidelines or expected practices were followed. When the review is complete, we advise the beneficiary, or representative, of our determination as to whether or not the care provided met professionally recognized standards of health care. If an instance or pattern of substandard or unnecessary medical care is identified, we work with the facility or physician in question to initiate a plan to correct the questionable practice. Although the reviewed care has already been provided to the beneficiary, that beneficiary and all others will receive better medical care from the facility or physician in the future because of the review and the corrective action taken to improve the practice pattern.