Patient/Client Complaints The Agency respects the right of the patient/client to voice complaints without fear of retaliation. A patient/client and/or family member may occasionally voice a complaint. Listen to the complaint! • Listening and acting may resolve the problem before it is uncontrollable. • Notify the Agency management immediately. • Document the complaint on a complaint form and submit it immediately. Upon admission, the patient/client has been informed of their right to call the state complaint hotline, if an issue cannot be resolved at the Agency level. The patient/client has been informed of the Medicare hotline number as well. The Agency encourages rapid resolution of an issue in order to respect the patient’s/client’s rights and to avoid an unnecessary complaint survey. Review the following policy and procedure: Online Bookmark Title of Policy Rights and Ethics (RI) Resolution of Patient Conflicts, Grievances, or Complaints Fraud and Abuse in Home Care The Agency code of conduct defines acceptable, disruptive, and inappropriate behavior of individuals working at all levels in the Agency, including management, clinical, and administrative staff, as well as governing body members. Areas included are fraud and abuse, as well as business and patient/client ethics. A discussion of each follows. Fraud and abuse in home care is a primary focus by government regulatory agencies. When fraud and abuse is investigated and proven, individuals and agencies are prosecuted. This can include the loss of one’s professional license, loss of agency licensure, monetary paybacks and penalties, and prison. The Agency will not tolerate fraud and abuse. Activities with a potential for fraud and abuse will be monitored. They include, but are not limited to the following: • Over-utilization of services • Falsified information about patient/client eligibility • False clinical record documentation • Illegal compensation • Falsification of visits performed
