Category: general

**Federal Watchdog Report Reveals “Ghost Networks” in Private Medicare and Medicaid Mental Health Plans**

A recent report from a federal watchdog has uncovered that companies running private Medicare and Medicaid insurance plans often inaccurately list mental health professionals as available to treat plan members. Investigators allege that some insurers have effectively set up “ghost networks” comprising psychologists, psychiatrists, and other mental health providers who supposedly agreed to treat patients covered by publicly financed Medicare and Medicaid plans.

In reality, many of these professionals do not have contracts with the plans, do not work at the listed locations, or have retired, the investigators found.

### Findings from the Office of Inspector General

The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS), which oversees Medicare and Medicaid programs, released the findings. Their report focuses on insurers paid by the government to cover people in Medicare Advantage plans and privately managed Medicaid plans—types of insurance that cover about 30% of all Americans.

The government pays these insurers hundreds of billions of dollars annually. Insurers receive fixed rates per enrollee and keep any unused funds. They are required to have an adequate number of healthcare professionals under contract in each region they cover.

However, the new report discovered that:

– **55% of mental health professionals listed as in-network by Medicare Advantage plans were not actually providing care to any plan members.**
– **28% of those listed in Medicaid managed care plans were similarly not providing care.**

### Providers and Locations Often Incorrectly Listed

Several mental health professionals told investigators they should not have been listed as in-network providers. Reasons included no longer working at the listed locations, not participating in the Medicare Advantage or Medicaid managed care plans, or having transitioned to administrative roles and not providing patient care.

In one striking case, a private Medicaid plan listed a mental health professional as offering care in 19 practice locations. However, when investigators contacted one clinic, a receptionist revealed the provider had retired several years prior.

### Real-World Impact on Patients

Jeanine Simpkins of Mesa, Arizona, experienced the consequences of these skimpy networks firsthand. This fall, she struggled to find a drug rehabilitation program that would accept the Medicare Advantage insurance held by a 40-year-old family member with a disability who was in crisis.

Simpkins contacted about 20 rehab programs, none of which would accept the insurance plan. “You feel kind of dropped,” she said. “I was pretty surprised because I thought we had something good in place for her.” Eventually, her relative enrolled in part-time hospital care instead of an inpatient rehabilitation center.

### Challenges of Accessing Mental Health Care

Accessing timely, nearby healthcare can be difficult for all sorts of health issues—from colds to cancer. However, Jodi Nudelman, a regional inspector general who contributed to the report, emphasized that the stakes are particularly high for mental health care seekers.

“Mental health patients can be particularly vulnerable,” Nudelman said. She explained that acknowledging the need for mental health care is often daunting, and any obstacles can discourage people from seeking help.

Nudelman also noted that taxpayers are not getting their money’s worth if insurers fail to provide sufficient care options for Medicare and Medicaid participants.

### Scope of the Investigation

The report examined a sample of 10 counties across five states: Arizona, Iowa, Ohio, Oregon, and Tennessee. The sample included both urban and rural areas. Importantly, the report did not name the insurers whose networks were evaluated.

Susan Reilly, vice president of communications for the Better Medicare Alliance—a trade group representing Medicare Advantage plans—responded to the findings. She stated that managed care companies support federal efforts to improve access to mental health services.

“While this report looks at a small sample of plans, we agree there’s more work to do and are committed to continuing that progress together with policymakers,” Reilly said.

The report’s authors believe their sample accurately represents the national situation, having reviewed 40 Medicare Advantage plans and 20 Medicaid managed care plans.

### Recommendations for Improvement

The investigators recommend that government administrators:

– Use medical billing data more extensively to verify whether listed in-network health professionals are actually providing care to plan members.
– Create a national, searchable directory of mental health providers that clearly indicates which Medicare and Medicaid insurance plans each provider accepts.

Such a directory would help patients find care more efficiently and enable easier verification of the accuracy of provider listings.

Federal Medicare and Medicaid administrators have already begun work toward establishing such a directory. The Better Medicare Alliance also expressed support for this initiative.

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*This report highlights significant challenges in the availability and transparency of mental health provider networks within private Medicare and Medicaid insurance plans, underscoring the critical need for accurate information and accessible care for vulnerable patients.*
https://www.cbsnews.com/news/private-medicare-medicaid-plans-mental-health-options-watchdogs/