Filing Complaints & Resolving Serious Issues With Oversight Agencies

When egregious problems and serious issues are not resolved through other efforts, file formal complaints with oversight agencies.

General Guidance for Filing Complaints (further details below)

  1. File a complaint first with the Massachusetts Department of Public Health Division of Health Care Facility Licensure and Certification (DPH), the state agency that enforces nursing home regulations through regular inspections and complaint investigations.
  1. If the problem involves care provided under Medicare, also file a complaint with Kepro (in addition to DPH). Kepro is the agency that handles Medicare complaints as detailed below.
  1. If the problem concerns an emergency, or a serious healthcare or financial issue, also file a complaint with the MA Attorney General, Health Care Division.
  1. If the issue is not resolved by DPH or Kepro, contact the Centers for Medicare and Medicaid Services (CMS) Regional Office noted below.
  1. Copy (i.e. “cc”) all correspondence to all parties you contacted regarding the complaint.  Also copy all agencies listed below (whether or not you actually formally contacted them), your local LTC Ombudsman, and the LTC Ombudsman main office to alert all to the problems and to receive support and information.

Executive Office of Elder Affairs Ombudsman Office (main office)
1 Ashburton Place, 5th Floor
Boston, MA  02108
Phone:  617-727-7750

   6. See below “Additional Actions” for further options to address serious care issues.

Massachusetts Department of Public Health

24-hour complaint hotline: 800-462-5540

How to file a complaint, including form: Complaints Regarding Nursing Homes and Other Health Care Facilities.

The Massachusetts Department of Public Health Division of Health Care Facility Licensure and Certification (DPH) upholds resident/patient rights in health care facilities in Massachusetts.  DPH enforces nursing home laws and regulations through regular inspections and complaint investigations.  This is the primary agency handling serious complaints that cannot be resolved through standard channels.  The agency reviews allegations of poor quality care, abuse, neglect, and misappropriation of funds.

It is MANHR’s experience that unless there is an immediate life-threatening problem, it could take DPH a couple of months to resolve a complaint investigation.  If the resolution is unsatisfactory, you should contact DPH and follow-up with a stronger letter to again be “on the record” with your concerns.

Medicare

Kepro handles Medicare appeals/complaints in MA: 888-319-8452.

Immediate Advocacy (IA) is an informal, voluntary process used by Kepro to resolve complaints quickly.

Kepro is authorized by Medicare to support the rights of Massachusetts residents on Medicare. These rights include healthcare protections and making sure entitled healthcare services are delivered, including rehabilitation and maintenance therapies (e.g. physical or speech therapies).  Contact Kepro if you or your loved one has Medicare coverage, and you are concerned about any healthcare delivery issue.

For example, if you or your loved one has Medicare coverage, and you want to file an appeal or healthcare complaint, Kepro will help you to:

  • Appeal a notice that the hospital intends to send you or your loved one back to the nursing home when you believe hospital care is still necessary.
  • Appeal a notice that states a course of treatment (e.g. rehabilitation) is going to end when you believe those services are still necessary.
  • Address other medical concerns, e.g. received wrong treatment, did not receive care instructions upon discharge, received infection while recuperating in the nursing home, etc.

Massachusetts Attorney General’s Office

Attorney General Medicaid Fraud Complaint Tip Line: (617) 963-2360

You also can file a complaint directly with the MA Attorney General Office (AG) about serious healthcare or financial issues in a nursing home.  The Medicaid Fraud Division reviews allegations of fraud in the MassHealth program, as well as reports of poor care and abuse against all residents in MA long-term care facilities.  The AG will also communicate with the Department of Public Health on the quality of care concerns you raise.

Please note: the AG’s office does not take action on individual complaints.  However, your filing of a complaint alerts the AG’s office to nursing home issues, so the AG can maintain statistics to establish patterns of serious nursing home infractions.  Your input will help hold nursing homes accountable  and could spur the AG to investigate harmful practices, sponsor legislation to change those practices, etc.

Centers for Medicare and Medicaid Services (CMS)

CMS Philadelphia Regional Office [includes Boston]: ROPHIDSC@cms.hhs.gov (800) 392-8896.  CMS Boston Regional Office Contact: (617) 565-1188

CMS is the federal agency that contracts with each state’s Department of Public Health to carry out nursing home surveys.  According to a 2/9/22 CMS guidance document, CMS, for the first time, directly suggests that complaints about quality of care may be made directly to regional CMS offices if states are not conducting surveys. If the above-noted options do not resolve your problem, contact the Philadelphia Regional CMS office which includes the Boston Regional Office.  While advocates have previously recommended that people contact CMS, CMS has never before told people to reach out to Regional locations to file complaints when state action is inadequate.  Hopefully, this new recommendation signals a renewed interest in enforcement.

Additional Actions

Here are some additional actions you can take to try to impact the speed with which your complaint is acted upon by an agency and, possibly, the outcome of your complaint.

Hiring a Lawyer – There are attorneys who are skilled in representing nursing home residents and their authorized representatives in situations where the nursing home may be violating the rights of the resident.  At times, a letter from an attorney “does the trick”, while other times, court cases are filed.  If you’re not sure about hiring an attorney, consider having a consultation about your concerns.  See Hiring a Lawyer – Some Options.

Contacting your US and State Legislators – Part of an elected official’s job is responding to constituent concerns and requests for help.  This applies to nursing home quality of care and life issues and the timeliness of a response by agencies contacted for assistance. Ask for help from your US Senator and Congressperson if it is a Medicare-related issue, and from your Massachusetts Senator and Representative if it is related to DPH or the nursing home. At a minimum, federal or MA legislators are usually willing to contact the agency or facility involved and let them know he/she has an “interest” in the quick disposition of your complaint.

See “Contacting Your Elected Officials” for contact information for your particular federal and state legislators.

Going Public to the Media – In rare cases, you may want to consider calling local media (e.g. newspapers, television, radio, online news sites) to share your story.  If it is compelling enough (as decided by the editors/producers at the media outlet), they will conduct their own fact-finding and may decide to run a story.  Even if a story does not run, an agency or nursing home getting a media inquiry about a complaint may feel the “pressure” to act quickly.

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