Twenty-four percent of maternal health providers on Medicaid managed care network lists sent to states are not actually in network, according to the HHS Office of Inspector General.
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.
In June, OIG released two maternal health reports, one looking at network lists sent to states and the other considering 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 Medicaid managed care.
Here are five numbers from the reports:
1. At 35%, Centene had the largest share of maternal health providers on the network list who were actually out of network, versus 19% at UnitedHealthcare and 18% at Elevance.
2. Overall, one-third of providers in the directories who reported being in network also documented at least one inaccurate phone number or address for themselves.
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. Looking across the plans, 22% 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.
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