A federal watchdog report found that more than half of mental health professionals listed in private Medicare Advantage directories were not treating patients in those plans, KFF Health News reported Oct. 20.
The HHS Office of Inspector General reviewed 40 Medicare Advantage plans and 20 Medicaid managed care plans across 10 counties in Arizona, Iowa, Ohio, Oregon and Tennessee. It found that 55% of listed mental health professionals in private Medicare Advantage directories, and 28% in private Medicaid managed care directories, were not providing care to plan members, a practice that essentially created “ghost networks.”
Some professionals were retired, no longer working at listed locations, or were misclassified as accepting insurance when they did not. In one instance, a provider was listed at 19 locations but had retired years earlier, the report said.
Jodi Nudelman, a regional inspector general, told KFF Health News the findings highlight critical gaps in access to behavioral health for vulnerable populations. About 30% of Americans are covered by private Medicare or Medicaid plans, which receive federal funds to deliver network adequacy, according to the OIG report.
