Skip to main content

Feds Find Doctor Listings Often Wrong In Medicare Advantage Directories

News  |  By Kaiser Health News  
   October 25, 2016

Provider directories for private Medicare Advantage plans are riddled with errors, according to the government's first in-depth review.

This article first appeared October 24, 2016 on Kaiser Health News.

By Phil Galewitz

Provider directories for private Medicare Advantage plans are riddled with errors, according to the government's first in-depth review.

The results made public Monday, arriving amid the annual enrollment period through Dec. 7, validate gripes long made by seniors and consumer advocates. The level of errors still surprised regulators, said officials from the Centers for Medicare & Medicaid Services who disclosed their findings at an industry conference in Washington.

Incorrect information was found for almost half of the 5,832 doctors listed in directories for 54 Medicare Advantage plans checked last fall, they said. Only online directories were examined.

The government hopes that a new rule this year will help raise that bar because it requires Medicare Advantage plans to contact doctors and other providers every three months and update their online directories in "real time."

CMS did not identify the names of insurers that were surveyed.

CMS' survey found the most error-prone listings involved doctors with multiple offices that did not serve health plan members at each location, said Christine Reinhard, a health insurance specialist in the CMS Division of Surveillance, Compliance and Marketing.

Explanations could be that the doctor was retired, worked at a different location or never worked at the address. Or maybe the doctor never had a contract with the Medicare health plan — a less likely possibility, according to officials.

Pages

  • 1

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.


Get the latest on healthcare leadership in your inbox.