Medicaid insurers' provider directories include doctors who are unavailable, not accepting new patients or could not be found, says a report from the Office of the Inspector General of the U.S. Department of Health and Human Services.
Since the Affordable Care Act has quickly increased Medicaid expansion, with many states contracting private insurers to administer their program, enrollment has grown by 16 percent (9 million beneficiaries) in expansion states in the last year, FierceHealthPayer previously reported. The problem, based on the OIG report, is that the growth has been accompanied by inaccurate provider networks.
After calling 1,800 providers listed by more than 200 insurers contracted to provide Medicaid coverage in 32 states, OIG investigators determined that more than one-third of providers couldn't be found at their location listed by the insurer. Plus, 50 percent of providers couldn't offer appointments to Medicaid members.
"In these cases," OIG Inspector Daniel Levinson said, "callers were sometimes told that the practice had never heard of the provider, or that the provider had practiced at the location in the past but had retired or left the practice. Some providers had left months or even years before the time of the call."
About 8 percent of the providers investigators called were at the locations listed, but they said they don't take the insurance they were supposedly listed as being affiliated with. Another 8 percent participated in Medicaid but weren't accepting new patients, noted the report.
Even the providers who were offering appointments to Medicaid patients had median wait times of two weeks. More than 25 percent had wait times of more than one month, and 10 percent had wait times exceeding two months.
The OIG noted that such long delays in getting appointments can cause major problems for patients. "A number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy."
To learn more:
- look at the OIG report (.pdf)