Nearly half of the provider directories of Medicare Advantage plans reviewed by the CMS are incorrect, the agency said.
Anthem, Aetna, Humana, UnitedHealthcare are among those put on notice to address the deficiencies. The CMS issued a total of 31 notices of noncompliance and 21 warning letters.
A report released Thursday by the CMS revealed 45.1% of provider directories of Medicare Advantage plans reviewed were not accurate. The agency examined the online provider directories of 54 Medicare Advantage plans, which represents approximately one-third of all MA plans, between February and August of 2016. Combined, these plans have a network of 5,832 providers.
The inaccuracies ranged from the provider not being at the location listed, wrong phone numbers and the listing incorrectly noting the provider was accepting new patients.
Within each MA plan directory, the percentage of inaccurate locations ranged from 1.77% to 86.53%, with an average rate of inaccuracy by location 41.37% across the MA plans reviewed.
“Because MA members rely on provider directories to locate an in-network provider, these inaccuracies pose a significant access to care barrier,” CMS said.
Of the 55 million people with Medicare coverage in 2015, roughly 17.7 million seniors and disabled Americans were enrolled in Medicare Advantage plans.
That year, the Government Accountability Office found that the CMS needed to do a better job ensuring that there are adequate networks for Medicare Advantage plans. The issue was raised following reports that some Advantage plans had been narrowing their provider networks, prompting concerns about ensuring access to care.
The CMS is conducting the second review round, which will examine online provider directories of an additional 64 MA plans. It did not say when findings from that review would be released.
If no action is taken by insurers to correct the inaccuracies, the government can penalize the companies $3,000 to $10,000 a day.
