The New York Attorney General’s office recently announced an agreement with MVP Health Care under which the insurer will pay $250,000 in penalties, fees, and costs to the state for maintaining an inaccurate mental health provider directory. The settlement is the first arising out of an investigation of so-called “ghost networks” by Attorney General Letitia James in 2023. The investigation spawned a report titled “Inaccurate and inadequate: Health plans’ provider directories for mental health networks.”
“Ghost networks” are health insurance directories that list providers who are unreachable, no longer accept the insurance, are not taking new patients, or simply do not exist. The AG’s 2023 investigation used “secret shoppers” who called providers listed in health plan directories, pretending to be consumers looking for treatment. Only 14% of the 400 calls resulted in an appointment being offered for in-network care, with the remaining providers considered ghost listings (including 100% of MVP’s listed mental health providers).
Ghost networks raise significant compliance concerns under state and federal laws requiring insurers to maintain accurate provider directories and adequate networks. This practice also makes it extremely difficult for patients to find timely in-network care, often forcing them to delay treatment or pay for costly out-of-pocket visits.
Under the settlement, MVP is required to implement a robust verification process for providers, including contacting each provider every 90 days to confirm their availability and current participation in the network. MVP must also adopt protocols to ensure timely responses to member inquiries and reimburse their members who were forced to find out-of-network care for mental health issues.
The chart in AG James’s report showing successful appointments vs. ghost listings suggests that similar actions against other insurers may be forthcoming.
