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Private Medicare, Medicaid Plans Exaggerate in-Network Mental Health Options, Watchdogs Say
A federal report found 55% of mental health providers listed in Medicare Advantage plans and 28% in Medicaid managed care plans were inactive, creating misleading network claims.
- The Office of Inspector General for the Department of Health and Human Services released a recent report showing companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as available to treat members.
- Insurers receive set per‑person payments and can keep unspent funds, while regional network adequacy requirements mandate adequate provider contracts that may not reflect actual care, the report says.
- In the sample review, investigators found 55% of mental health providers listed by Medicare Advantage plans and 28% by Medicaid managed care plans were not treating members, including a provider listed at 19 locations who retired a few years ago.
- Report authors recommend using billing records to verify care, and a proposed national, searchable directory would aid caregivers and patients seeking timely mental health care affecting about 30% of Americans covered by Medicare Advantage or privately managed Medicaid plans.
- The report's authors say their sample of 10 counties in five states, including urban and rural areas, broadly represents the national situation, while insurers remain unnamed.
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Private Medicare, Medicaid plans exaggerate in-network mental health options, watchdogs say
A federal probe of Medicare and Medicaid plans run by private insurance companies found that the plan operators often overstated how many mental health providers were available in their networks.
·United States
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littlebytesnews.comPrivate Medicare, Medicaid Plans Exaggerate In-Network Mental Health Options, Watchdogs Say
Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans’ members, a new federal watchdog report says. The investigators allege that some insurers effectively set up “ghost networks” of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered by the publicly financed Medicare and Medicai…
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Total News Sources27
Leaning Left2Leaning Right0Center19Last UpdatedBias Distribution90% Center
Bias Distribution
- 90% of the sources are Center
90% Center
C 90%
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