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CMS: Medicare Advantage Provider Directories Have Significant Deficiencies

A review of Medicare Advantage online provider directories revealed that 45% of listed provider locations are inaccurate, according to a recent report from the Centers for Medicare & Medicaid Services (CMS).

The review, conducted from February-August 2016, uncovered listing errors including the following:

  • the provider was not at the location listed,
  • the phone number was incorrect, or
  • the information concerning acceptance of new patients was inaccurate.

This review by CMS was undertaken pursuant to a September 2015 report from the U.S. Government Accountability Office (GAO). The GAO recommended that CMS ensure MA plans had adequate networks. The GAO recommended that the CMS administrator assist with oversight of MA networks and address provider availability, verify provider information, conduct more periodic reviews network information, and ensure minimum information requirements notification letters sent to MA enrollees. This review is a first step to rectify the issues addressed in the GAO report.

CMS intends to review all MA plan directories over the course of three years by examining approximately one-third of all MA plans each year. The goal is to gain a better understanding of provider directory accuracy and identify best practices. CMS will take appropriate compliance actions to ensure industry improvement in providing accurate provider directories. Anthem, Aetna, Humana, and UnitedHealthcare are among those MA providers put on notice to address the deficiencies. CMS issued a total of 31 notices of noncompliance and 21 warning letters. If no action is taken by insurers to correct the inaccuracies, the government can enforce penalties of $3,000 to $10,000 a day.