Competitive Acquisition Ombudsman FAQ

All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expired on December 31, 2018. As of January 1, 2019, there is a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020. For additional information, please see the Temporary Gap Period (PDF) fact sheet.

Frequently Asked Questions  

Common questions about the Competitive Acquisition Ombudsman

The following is a list of frequently asked questions about the Competitive Acquisition Ombudsman (CAO) for Medicare’s Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

On this page:

  1. What is an ombudsman?
  2. Who is the CAO and what does the CAO do?
  3. What has the CAO accomplished?
  4. How can the CAO work with you?
  5. Will my privacy be respected?
  6. What to do if you have a complaint or inquiry?
  7. When I contact 1-800-MEDICARE, what should I include?
  8. What emergency preparedness resources are available?  

 

1. What is an Ombudsman?

An Ombudsman is an appointed official who receives, investigates, reports on, and helps settle or facilitates resolution of complaints about a program. Ombudsman offices are in federal, state, and local governments; academic institutions; for-profit businesses; and in non-profit organizations. In general, ombudsman programs are independent, impartial, confidential, and use a credible review process. Ombudsmen also make recommendations for the resolution of systemic problems under their purview to those persons who have the authority to act upon them.

2. Who is the CAO and what does the CAO do?

The CAO is a federal official whose role was established through Section 154 of the Medicare Improvements for Patients and Providers Act of 2008 to respond to suppliers’ and individuals’ complaints and inquiries about the Competitive Bidding Program and provide an Annual Report to Congress. The CAO also analyzes data related to the Competitive Bidding Program to identify potential systemic issues and make suggestions to the Agency about the possible need to address trends that appear in these data.

The CAO works closely with CMS components and its contractors, as well as with external partners, to:

  • Respond to suppliers’ and individuals’ complaints and inquiries;
  • Assist CMS in ensuring that issues are resolved; and
  • Assist CMS in ensuring that a comprehensive process for timely responses to suppliers and individuals is in place.

3. What has the CAO accomplished?

The CAO is required to produce an Annual Report to Congress. These reports contain information about the activities that the CAO has been engaged in during the year. Some key accomplishments have included identifying and raising complaints and inquiries to Agency leadership, conducting feedback forums and listening sessions with external partners and suppliers, and working with others in CMS to establish caseworker trainings and improvements to the customer service program. The CAO’s Annual Reports to Congress are available in the Downloads section of the Competitive Acquisition Ombudsman’s Web page.

4. How can the CAO work with you?

Typically, the CAO assists with complaints and inquiries, specifically:

  • if you are a beneficiary or caregiver, you might have an inquiry about specific durable medical equipment, or a service.  
  • if you are a supplier, you may have a complaint or inquiry about program policy.  

The CAO receives and assists with unresolved complaints from beneficiaries and suppliers that have failed to be resolved at the existing support mechanism.  The CAO works with subject matter experts in CMS to identify options for resolving complaints and inquiries, may make referrals, or serve as a mediator.  

5.  Will my privacy be respected?

The CAO strives to maintain confidentiality to the extent possible. Depending on the nature of your complaint or inquiry, the CAO may share your complaint or inquiry with others in CMS to identify options for resolution. The CAO may be unable to keep your complaint or inquiry confidential if it deals with public safety, harm to self or others, violations of law, discrimination, or sexual harassment.

6.  What to do if you have a complaint or inquiry?

If you have a problem getting needed DMEPOS items or services or if you are concerned about the quality of the supplies and services you are receiving, there are several ways that you can get help.

  1. Contact your supplier.  If you already have your DMEPOS item(s) but are having problems getting needed supplies or services, you should first contact your supplier.  Your supplier:
    • Must provide regular business hours and after-hour access telephone number(s).
    • Is obligated to acknowledge your complaint and respond to you.
    • Must let you know they received your complaint and are investigating it within 5 calendar days.
    • Must send you the result of your complaint and provide his or her response in writing within 14 calendar days.
  2. Call 1-800-MEDICARE.  1-800-633-4227 to get help.  TTY users should call 1-877-486-2048.  If you need help in a language other than English or Spanish, say “Agent” to talk to a customer service representative.
  3. Contact the CAO.  If you have contacted the supplier and 1-800 MEDICARE, but still need help, ask the 1-800-MEDICARE representative to submit your complaint or inquiry to the CAO.  The CAO helps to ensure that your complaint/inquiry is resolved.

7.  When I contact 1-800-MEDICARE, what should I include?

When contacting 1-800-MEDICARE, please include the following information:

  • Detailed information about your complaint or inquiry
  • The Competitive Bidding item(s) or supply(ies) in question
  • The zip code in which you reside

8. What emergency preparedness resources are available?   

The CAO provides a Emergency Preparedness and Response website with information related to the continuity of care for DMEPOS users and Medicare beneficiaries during emergency or disaster situations.  You will find information about the following:

  • How to contact FEMA to determine if your area is a disaster or emergency area
  • How to replace lost or damaged durable medical equipment or supplies in a disaster or emergency
  • How to contact your equipment supplier
  • How to replace a lost Medicare card or Medicare plan membership card
Page Last Modified:
01/02/2019 07:24 AM