- A new report from the Government Accountability Office says CMS needs to look closer at whether Medicare Advantage plans are providing sufficient provider networks.
- The agency's current oversight is deficient in several ways, the report says, including its failure to consider whether listed providers practice significant hours at a particular location or are accepting new patients.
- "Without taking availability into account, as is done in some other programs, MA provider networks may appear to CMS and beneficiaries as more robust than they actually are,” the report states.
In addition to ignoring issues of provider availability, CMS has neglected to verify the information of listed providers, leading to outdated and inaccurate information, the GAO says.
The concerns about availability and accuracy are amplified by the trend toward narrower provider networks, which mean even fewer choices for patients, Modern Healthcare notes.
According to U.S. Sen. Sherrod Brown (D-OH), one of the legislators who requested the report, MA plans have removed thousands of providers and sites of service after seniors have enrolled. "This sort of blatant bait and switch should not be allowed," he said in a prepared statement.
The GAO report recommends CMS:
- Update its MA network adequacy criteria to include provider availability;
Verify submitted provider information;
Periodically assess networks against current Medicare requirements; and
- Set minimum requirements for letters that notify enrollees of provider terminations.