Medical Complaints

Q: I am receiving a lot of Medicare Summary Notices that I do not think are accurate. Is this fraud and should I report this?
A: The North Carolina Senior Medicare Patrol (NCSMP) Program is housed within the Seniors’ Health Insurance Information Program (SHIIP) at the North Carolina Department of Insurance. NCSMP is a preventive educational program whose goal is to reduce Medicare error, fraud and abuse through statewide coordinated efforts of educational and promotional activities. They encourage reporting of discrepancies by Medicare beneficiaries and caregivers to the NCSMP Program.

The process of reporting suspected Medicare fraud, abuse and waste is:

1. contact the medical provider to seek resolution;
2. contact the insurance company; then
3. file an appeal by following the appeal instructions found on the back of the Medicare Summary Notice.

If your situation is not resolved satisfactorily, you should contact the NCSMP Program at the nationwide toll-free number, 855.408.1212.

1. I have a concern about my care and billing while I was in the hospital. Who do I contact?

Q: I have a concern about my care and billing while I was in the hospital. Who do I contact?
A: The large medical centers have a Patient Relations Department. Members of the patient relations team act as patient representatives and address patient concerns and complaints to resources issues as quickly and efficiently as possible. All patients are provided a Patient Bill of Rights and Responsibilities upon admittance and receive a patient satisfaction survey after discharge. For more information regarding this policy at Forsyth Medical Center click here and for Wake Forest Baptist Medical Center click here.

Back to Directory of Services