A pair of new reports from the Office of Inspector General raises concerns about "ghost networks" for maternal services in Medicaid.
The Department of Health and Human Services' watchdog analyzed provider directories for three of the largest managed care organizations—Centene, Elevance Health and UnitedHealthcare—across five states. OIG found that all three had providers listed in their directories who were not in-network.
For Centene, this was 22% of maternal health providers, while it was 6% for UnitedHealthcare and 4% for Elevance. In addition, 35% of in-network providers were missing from Centene's directory, according to the report, as were 25% of those in-network for UnitedHealth and 11% of in-network providers at Elevance.
OIG also found that 41% of in-network providers in Elevance Health's directory listed inaccurate contact information, as did 37% of those in-network for Centene and 22% of UnitedHealthcare's in-network maternal health providers.
The agency noted that comprehensive networks for maternal care in Medicaid are critical as the program pays for more than 40% of births, and most pregnant Medicaid enrollees are in managed care plans.
In addition, OIG said that maternal health has remained a significant challenge across the country, making it even more crucial for oversight into access.
"The United States is experiencing a maternal health crisis, with worse outcomes than in any other high-income country," OIG wrote in the report. "Access to maternal health care in Medicaid managed care impacts the nation’s overall maternal health outcomes."
In the report, OIG recommended that the Centers for Medicare & Medicaid Services do more to hold managed care organizations accountable for their provider directories, and CMS concurred with the suggestion.
The agency also issued a companion report that warns inaccurate provider directories may make it harder for states to monitor access to maternal health services in their Medicaid programs. State officials are responsible for ensuring that plans offer comprehensive services, and lists of network providers offered from the insurers are a key tool in that effort, per the report.
However, if those lists are inaccurate, their oversight functions are limited, OIG said.
OIG recommended that CMS work with states to ensure that provider data is accurate and support them in holding MCOs accountable. CMS concurred with both suggestions.
These so-called "ghost networks" have gotten multiple insurers in hot water. A similar report from OIG released in October warned that Medicare Advantage and Medicaid managed care plans can lack comprehensive networks in behavioral health.