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Medicare Advantage Directories Remain Full of Errors Due to CMS Inaction


It is important that Medicare Advantage organizations (MAOs) supply complete, accurate, and accessible provider directories to ensure that those who enroll in Medicare Advantage (MA) plans know which providers are in a given plan’s network. Unfortunately, as we have highlighted before, MAO provider directories are not complete and accurate. Instead, for the third year running, the Centers for Medicare & Medicaid Services (CMS), the agency that runs the Medicare program, has revealed directory audit results showing widespread errors and inaccuracies.

In 2017’s audit report, CMS found that 45.1% of provider directory locations listed in these online directories were inaccurate. In the early 2018 report, 52.20% of the provider directory locations listed had at least one inaccuracy. Now, the third such report shows that 48.74% of the provider directory locations listed had at least one inaccuracy. The types of inaccuracies remain the same: the provider was not at the location listed; the phone number was incorrect; or the provider was not accepting new patients when the directory indicated they were.

These inaccuracies put people with Medicare in a difficult position. Not having access to accurate directories when they are making decisions about their Medicare options can lead to beneficiaries choosing MA plans based on illusory networks. Coupled with CMS’ current campaign that blatantly favors MA over Original Medicare, risks are mounting that people will mistakenly enroll in an MA plan that is not right for them. Once enrolled, they may find that they are reaching out to doctors that are unreachable, not in the areas they expected, not accepting new patients, or perhaps not part of the network at all. There’s even a chance that people with Medicare could suffer from lack of access to care by choosing a network without providers that are accessible or genuinely accepting new patients.

We are disappointed that there has been no effective effort to combat these widespread errors. In the 2017 report, CMS announced they had sent 31 Notices of Non-Compliance, 18 Warning Letters, and 3 Warning Letters with a Request for a Business Plan. In the early 2018 report, they announced 23 Notices of Non-Compliance, 19 Warning Letters, and 12 Warning Letters with a Request for a Business Plan. In this latest report, 18 Notices of Non-Compliance, 15 Warning Letters, and 7 Warning Letters with a Request for a Business Plan were sent.

Earlier this year, CMS reiterated previous warnings that “[monetary penalties] and other enforcement actions may be imposed,” but this has not happened despite the agency’s declaration that “Inaccurate provider directories can impede access to care and bring into question the adequacy and validity of the Medicare Advantage Organization’s (MAO’s) network as a whole.”

More must be done to ensure people with Medicare have access to complete, accurate information about MA networks prior to making important Medicare decisions. The lack of progress on this front is disheartening but reversible through strong oversight and appropriate penalties for a failure to improve directory accuracy.

Read the newest audit report.

Read our commentary on previous audit reports: 2017, 2018.

Read more about provider directory errors.

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