POMS Reference

DI 39545: Purchased Medical Services

BASIC (09-06)

A claimant complaint is any written or verbal communication which raises an issue with the CE provider, the facility, the staff or circumstance of the CE.

A. Policy

All complaints will be investigated and treated seriously. DDSs are required to investigate all claimant complaints and take appropriate action per their State procedures, and notify the RO and DCO-ODD as appropriate.

B. Procedure

The complaint should be written, preferably signed by the claimant, except in rare instances. Claimant complaints may be further defined as follows:

  • Rudeness and/or unprofessional manner/attitude.

  • Environmental factors (uncleanliness, poor accessibility, and/or lack of proper facilities).

  • Other complaints of a non-egregious nature.

  • Any allegation of an egregious nature which could include illegal/criminal activity, sexual harassment, cultural insensitivity, allegations compromising the health and safety of claimants, or other serious allegations.