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Author Topic: New QIO 3 year cut-off for complaint filing. Anyone heard of this?  (Read 1688 times)
ShirleyP
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« on: March 07, 2014, 07:12:08 PM »

  I had made a serious allegation about my previous senior advantage provider one of their physicians to the CA QIO at the end of last year. Originally a grievance to the provider by my son (they have durable power - medical on file for him), he was contacted by a senior investigator and he told her many instances of below standard care. The night he spoke with her, the ranges on some of my online Lab Results were changed and a diagnosis was removed on a date that an ER patient record mixup occurred (also just reported). While not directly related to the major complaint, it removed any trust we had. There was no contact about the grievance for over 2 months and only after I had been speaking with their patient advocate. 3 days after that I got a letter saying the matter was closed because I did not provide authorization for them to speak to my son. I then made a complaint detailing all those same instances to the Office of the Inspector General for the Dept of Health and Human Services, but they only take the anonymously, so I couldn't follow up. So I let it go.

  Back to the QIO. My original complaint to the was only about the one physician. Before I signed and returned their authorization form, I found out that our QIO was partly spawned by a Colorado HMO that shares the same parent organization as my previous provider. I was sure going forward with this would have only given them another chance to clean up.   

   At the beginning of this year I got a letter from Health Integrity, LLC, a NBI contractor for CMS. They stated their automated search application had flagged a complaint I had made. After speaking with them, I asked if this was about the complaint to the OIG, they said yes. They sent a letter telling me they had forwarded their findings to my Regional CMS office and gave me the name of my caseworker there. I was kind of busy at the time so I couldn't call them for a couple of days. In the meantime, my caseworker left 2 messages stating she was in contact with a manager at our QIO, trying to clarify my complaint. I also had four calls from the customer service dept of my ex-provider wanting to clarify my complaint. Yes, someone (CMS or NBI contractor or QIO) had contacted my previous provider, prior to any authorized investigation. Interestingly, the CMS caseworker, after listening to all my complaints, said she was only aware of the one complaint about a physician. So I'm not sure if the NIB contractor had the right complaint or even looked into all the other stuff I told them.

  Now that ex-provider has had a chance to cover up again, I didn't see much use in going forward, but my CMS caseworker talked me into calling the QIO manager she had been speaking with. Since there was a chance that my ex-provider was only told of the QIO compaint, I contacted the QIO manager.

   She told me that new CMS rules prohibit them from looking into any complaints about care that happened over 3 years old.Which wipes out my major complaint. Funny that they didn't have any problem looking into it when i filed my first complaint late last year. I read through all 900 pages of the recent Medicare changes and couldn't find anything relating to a new time limitation on complaints. I called my local SHIP office. I got a call back. The person said she wasn't aware but that she'd ask her manager. I never heard back. Anyone else heard of anything similar.

ShirleyP
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obsidianom
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« Reply #1 on: March 08, 2014, 03:43:42 AM »

I dont know for sure about complaints but as a doctor we are audited by CMS for our work at times , and they only go back 3 years. From what I was told congress allowed more but the standard cutoff is being held at 3 years.   
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My wife is the most important person in my life. Dialysis is an honor to do for her.
NxStage since June 2012 .
When not doing dialysis I am a physician ,for over 25 years now(not a nephrologist)

Any posting here should be used for informational purposes only . Talk to your own doctor about treatment decisions.
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