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December 7, 2018

Medicare Advantage provider directories often inaccurate, federal audit finds

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    Nearly 50% of Medicare Advantage (MA) directories that beneficiaries use to find a provider contained at least one inaccuracy, according to a federal audit released last week. 

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    Audit findings

    Overall, the audit, which focused on 108 providers listed in 52 MA organizations' online directories, showed 48.7% of the provider directories had at least one error. The audit showed error rates for each MA organization ranged from 4.63% to 93.02%. The errors flagged in the audit included incorrect provider locations and phone numbers. According to the audit, some of the directories also wrongly said the provider was accepting new patients.

    The audit results mark the third consecutive year that MA plan provider directories have contained widespread errors.

    Some call for tougher response

    CMS said that officials have not issued any fines over the inaccuracies, but have sent out 18 noncompliance notices, 15 warning letters, and seven warning letters asking for a business plan. MA plans have 30 days to address the issues.

    A CMS representative said, "CMS expects all (managed-care plans) to conduct a comprehensive review of all their provider directories."

    However, some experts say CMS should be taking a stronger stance against the plans.

    Mike Adelberg, a principal at Faegre Baker Daniels Consulting who worked at CMS from 2012 to 2015, said, "Another year with a lot of errors and another year of warning letters."

    Linda Borths of Quest Analytics said, "CMS is giving plans a lot of leniency because they understand it's not a problem that will solve itself overnight."  She added, "Getting the system cleaned up is going to take a lot of effort."

    MA open enrollment ends this week

    The news comes as CMS makes a final publicity push to encourage Medicare beneficiaries to enroll in plans before the open enrollment period ends Friday. CMS has sent emails touting the private MA plans. The subject line of an email dated Oct. 25 read, "Get more benefits for your money." Another email sent the following week stated, "See if you can save money with Medicare Advantage."

    CMS Administrator Seema Verma denied claims that the agency was attempting to steer beneficiaries to private plans. "We are not steering any Medicare beneficiary anywhere," she said (Pear, New York Times, 12/1; Winfield Cunningham, "PowerPost," Washington Post, 12/4; Luthi, Modern Healthcare, 12/4).

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