News: Quarter of providers on maternal health managed Medicaid network lists are ‘ghost providers,’ OIG found

In a recent review by the United States Officer of Inspector General (OIG), 24% of maternal health providers on Medicaid-managed care network lists sent to states are not actually in network. These listings are commonly referred to as “ghost providers,” meaning they appear on online provider directories or network lists, but do not have in-network status.

The OIG released a companion report that evaluated the accuracy of network lists that Medicaid managed care plans send to states. In the two companion reports, one looked at network lists sent to states and the other considered enrollee-facing online provider directories.

The reports reviewed network lists and directories across five states from Centene, Elevance Health, and UnitedHealthcare, the three largest companies in the Medicaid managed care.

The following are five significant findings from the reports:

1. One-third of providers in the directories who reported being in network also documented at least one inaccurate phone number or address for themselves.
2. Centene had the largest share of maternal health providers on the network list who were actually out of network at 35%, versus 19% at UnitedHealthcare and 18% at Elevance.
3. Twenty-one percent of in-network maternal health providers in provider directories said they did not currently work from at least one of the listed locations.
4. Of the providers who reported not being in network, 77% were not listed in the online provider directories, indicating online provider directories were more representative for this group than network lists sent to states.
5. Twenty-two percent of providers reported as in network were not listed in their respective plan’s online provider directory. For Centene, 55% of in-network providers from the network list were not in the provider directory, followed by 44% for UnitedHealthcare and 39% for Elevance.

Based on these reports, OIG recommends CMS to take steps to support states in holding Medicaid managed care plans accountable for the accuracy of their online provider directories. CMS concurred with this recommendation.

Editor’s note: To read the full report from OIG, click here. To read additional coverage from Becker’s Payer Issues, click here.