The New York Attorney General’s Office imposition of a $250,000 penalty on MVP Health Care for maintaining an inaccurate mental health provider directory riddled with “ghost” providers was recently discussed here. The problem, however, extends beyond New York. The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a report revealing that many Medicare Advantage and Medicaid Managed Care plans suffer from the same problem: limited behavioral health networks and a high number of inactive providers.
The OIG’s review examined four Medicare Advantage and two Medicaid managed care organizations across 10 counties, encompassing a total of 60 plans. The sample included both urban and rural areas from states across the country to ensure geographic diversity. The findings were troubling: more than half of the Medicare Advantage plans and roughly one-third of the Medicaid plans had directories in which at least one-third of the listed behavioral health providers were inactive. In some cases, the inaccuracies were far more severe — in 18 Medicare Advantage plans and one Medicaid plan, over 60% of the network providers had not delivered a single service to beneficiaries.
To better understand these discrepancies, OIG followed up with a random sample of inactive providers. The results showed that 72% of those providers should never have been listed in the networks at all. Most commonly, this occurred because the providers were no longer affiliated with the facilities listed by the plans. In other instances, the providers indicated that they would not accept patients covered under those plans or had never enrolled as network participants in the first place.
In response, the OIG urged the Centers for Medicare & Medicaid Services (CMS) to take several corrective actions:
- Use available data to actively monitor provider networks and strengthen the accuracy of Medicare Advantage directories.
- Partner with states to enhance the reliability of network directories in Medicaid managed care.
- Continue evaluating the potential for a national provider directory to improve accuracy and streamline administrative processes for both patients and providers.
