A new Office of Inspector General (OIG) review finds that many Medicare Advantage and Medicaid managed care plans have limited networks of behavioral health providers, further weakened by the inclusion of inactive or “ghost” providers who are not actually seeing patients. OIG found that some listed providers no longer worked at the locations shown in network directories or declined to see patients from the plan altogether, making networks appear larger than they are. The report highlights that 72 percent of inactive behavioral health providers should not have been listed in the network. OIG noted providers cited administrative burdens and low payment rates as reasons for opting out of participation in these plans. 

Despite CMS’s efforts to improve behavioral health access for Medicare and Medicaid beneficiaries over the last several years, this latest report indicate significant room for improvement. To address these issues, OIG recommended that the Centers for Medicare & Medicaid Services (CMS) use data to better monitor network adequacy, work with states to improve directory accuracy, and continue exploring a nationwide provider directory to reduce errors and ease administrative strain.