Widespread Inaccuracies in Medicare Advantage Provider Directories Uncovered

For years, Medicare Rights has encouraged the Centers for Medicare & Medicaid Services (CMS) to ensure that Medicare Advantage (MA) plans publish provider directories that are accurate and easily available to people with Medicare. Last week, CMS announced findings from a review of 54 MA organizations showing widespread inaccuracies in MA provider directories published online. According to the review, around 45% of the provider directory locations listed in these online directories were inaccurate.

Such inaccuracies can present significant challenges for people with Medicare. As beneficiaries choose which MA plan to enroll in, or as enrollees of an MA plan try to contact providers, 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. Because of this risk, CMS warned 21 of the MA plans with the most egregious errors that they might face monetary penalties or even be barred from enrolling new beneficiaries if they do not fix the online directory problems by February 6th.

In addition to the report and subsequent warnings, CMS released additional guidance reiterating the rules MA organizations must follow for provider directories. Medicare Rights continues to encourage CMS to do more to ensure MA organizations give only accurate and timely information to potential and current enrollees about their provider networks.

Read the full review report.