How to File a Complaint About Your Healthcare Provider

If you think your healthcare provider has acted wrongly, there are ways to report a doctor for unprofessional behavior.

Healthcare providers, like anyone, are human and can make mistakes. Sometimes your healthcare provider’s practices may be inappropriate or unethical. In other cases, you may feel you have received less than quality care, been mistreated, or been put at risk by your healthcare provider.

When your healthcare provider is to blame for something wrong that happened to you, there are avenues you can take to file a complaint. This article walks you through the process, from figuring out whom to speak with to how to report a doctor or other healthcare provider for unprofessional or unethical behavior.

Where to Lodge a Complaint

The first step is to assess who you should complain to. In some instances, you can complain directly to your healthcare provider. Other times, you may need to talk to the hospital administrator or the state licensing board. It depends on the problem and how convinced you are that it was intentional.

Talk to your or another healthcare provider in the following situations:

• Minor grievances: If you like your healthcare provider overall but have a few complaints, provide feedback directly to your healthcare provider. Talk to your provider about your expectations and concerns, like wanting your phone messages returned.
• Medical record error, but good medical care: If you notice an error in your medical record, but your medical care has been good, you should bring it up to the healthcare provider and office staff. They are highly likely to correct it to your satisfaction.
• Insulting behavior: If you feel that were insulted by your healthcare provider, then you might be more comfortable talking to someone else on the team, such as your nurse, the physician assistant, or another healthcare provider. Sometimes another person can look at things objectively and can guide your healthcare provider to avoid repeating this problem—with you as well as other patients. If the situation bothered you so much that you don’t want to see that healthcare provider again, tell the office staff why you won’t be using that healthcare provider’s services again.

Lodge a formal complaint if any of the following situations apply to you:

• Discriminatory behavior: If the insult or behavior was directed at you because of race, gender, sexual orientation, age, or religion, there are civil actions you can take, including contacting the Office for Civil Rights at the Department of Health and Human Services.
  
• Unethical billing: If you suspect that there may have been illegal or unethical billing practices, including fraudulent billing, upcoding (inaccurate billing codes submitted to receive inflated reimbursements), and balance billing (a bill for the difference between what your insurance paid and the cost of service), you can file an appeal with your health insurance company. If your appeal is denied, your healthcare provider may have a patient advocate who can help you free of charge. If you still can’t find a resolution, contact your state’s consumer assistance program or insurance department.
• Medical harm: If a medical error results in personal injury, hospitalization, disability, diminished quality of life, or death, report the matter to the hospital or practice manager. You will need to do so with an attorney if you are seeking damages or planning to litigate.
• Quality-of-care complaint: File a complaint with your state medical board if you did not receive quality of care. This can include medication errors, unnecessary or inappropriate surgery or treatment, not getting treatment after a change in your condition, getting discharged from the hospital too soon, and not receiving complete discharge instructions. File Medicare complaints with your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).
• Inappropriate sexual behavior: If your healthcare provider was sexually inappropriate or abusive in any way, contact the state medical board and file a police report.

How to Lodge a Complaint

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To file a formal complaint against your healthcare provider for unprofessional behavior, contact your state medical board.

Many government and institutional authorities allow you to file a complaint directly on their websites. For others, you may need to write a letter to send in the mail. In either case, there are guidelines you should follow to improve your chances of getting a reply:

• Keep your letter concise. The content should be no more than a few paragraphs, written in short sentences on a single page. Be specific about your complaints. If possible, use a bulleted list to make your points.

Remain objective. Tell what happened as simply as possible rather than describing how you felt. The point is to highlight the inappropriate behavior, not your response to it.

• State what action you would like to be taken. If you are reasonable in your expectations, then your complaint is more likely to be taken seriously. For example, if your healthcare provider overbilled you, then suggesting that the healthcare provider should be in jail can make you seem unreasonable. If you ask for a refund, you are likely to receive it. Leave the legalities to the authorities.
• Get help if you are unable to express yourself. If you have trouble communicating what happened or what you want, ask a family member to help or consider hiring a patient advocate experienced in these matters.

Finally, don’t go in assuming that your efforts will be for naught.

According to the Department of Health and Human Services Office for Civil Rights, of the 356,287 HIPAA complaints received, 99% were investigated and resolved.

If your complaint is appropriate and properly directed, the chances are good that it will be heard.

What Happens After You File a Complaint?

Hospitals, practice managers, government offices, and state medical boards investigate and record complaints, even those that are not deemed actionable. These agencies know that not all complaints are fair to healthcare providers.

However, when multiple complaints are received and a pattern of behavior is established, serious action against the healthcare provider will be taken. The healthcare provider’s ability to practice can be interrupted temporarily or permanently if necessary.

A medical malpractice attorney can help you determine whether starting a medical malpractice lawsuit makes sense. A lawsuit can help you recover losses resulting from the incident.

Summary

You may not always get the satisfaction you want when you report a doctor for unprofessional behavior. But that does not mean that you shouldn’t act.

Talk to your healthcare provider directly to provide feedback on how your care can be improved. Take more serious complaints to another healthcare provider, the hospital administrator, the state medical board, or a government authority.

By evidencing inappropriate, illegal, or harmful behavior, you can help protect others from experiencing the same problem you experienced.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Department of Health and Human Services. How to file a civil rights complaint.
2. Centers for Medicare & Medicaid Services. How to appeal an insurance company decision.
3. Patient Advocate Foundation. A patient's guide to navigating the insurance appeals process.
4. Medicare. Filing complaints about a doctor, hospital, or provider.
5. Federation of State Medical Boards. Addressing sexual boundaries: guidelines for state medical boards.

• Department of Health & Human Services. Enforcement Highlights.

By Trisha Torrey
Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system.