Private Medicare, Medicaid plans exaggerate in-network mental health options, watchdogs say

[BumRushDaShow]

Source: CBS News

October 20, 2025 / 5:00 AM EDT


Companies running private Medicare and Medicaid insurance plans inaccurately list many mental health professionals as being available to treat the plans' members, a new federal watchdog report says.

The investigators allege that some insurers effectively set up "ghost networks" of psychologists, psychiatrists, and other mental health professionals who purportedly have agreed to treat patients covered by the publicly financed Medicare and Medicaid plans. In fact, many of those professionals do not have contracts with the plans, do not work at the locations listed, or are retired, the investigators said.

The Office of Inspector General for the Department of Health and Human Services, which oversees the giant Medicare and Medicaid health programs, released its findings in a recent report. The report focuses on insurers the government pays to cover people in Medicare Advantage plans and in privately managed Medicaid plans. About 30% of all Americans are covered by such insurance, the report says. The government pays the insurers hundreds of billions of dollars annually.

The companies are paid set rates per person they cover and are allowed to keep whatever money they don't spend on patient care. The insurers are required to have adequate numbers of health care professionals under contract to serve patients in each region they cover. But the new report found that 55% of mental health professionals listed as in-network by Medicare Advantage plans were not providing such care to any of the plans' members. The figure was 28% for Medicaid managed care plans.

Read more: https://www.cbsnews.com/news/private-medicare-medicaid-plans-mental-health-options-watchdogs/

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Link to HHS OIG REPORT (PDF) - https://oig.hhs.gov/documents/evaluation/11233/OEI-02-23-00540.pdf

[Skittles]

1. ooh look, more "Advantage" scams

zzzzzzzzzzzzzzzzzzzzzzzz

[slightlv]

6. Tell me why I'm not surprised!

There's going to be so much expensive crap with the new plans... hubby has first dibs on hospital visits in this house because he's "prone" to heart attacks (3 so far). I won't go unless I feel like I've broken or are at death's door. Just too expensive for both of us to do hospital visits in the same year...

[bucolic_frolic]

2. I think they see patients when they have idle capacity

National car repair everywhere, anywhere, anytime do that. You get a great deal but at their convenience, not yours.

[erronis]

5. It's much worse than that. I doubt many MH professionals have any "down" time.

This is intentional by the Advantage insurers. As the lead mentions the plans include professionals who have retired, are no longer in the area, not taking new patients, etc.

It's like them advertising free dental services which only includes a new toothbrush every year.

[Passages]

3. I wish Trump was the only scam artist in America.

But far from it.

[Silent Type]

4. Good to see this report and recommendations. Unfortunately, it ain't much better on Traditional Medicare.

Though a bit better. I think the real problem is a big chunk of behavioral specialists prefer to charge patients directly.


"Between the two programs, there was generally more availability and shorter wait times for those covered by Medicaid:
43% of providers were not available to take on patients with Traditional Medicare,
53% could not take on Medicare Advantage patients,
44% couldn’t take on adults with Medicaid while 42% couldn’t take on children with Medicaid."


https://bhbusiness.com/2025/07/02/45-of-behavioral-health-providers-not-taking-medicare-medicaid-patients/


I have worked with large behavorial health practices that do mostly Medicaid. They get paid less than Medicare or MA (as much as 50% less in some states), but I think they enjoy it a lot more than the money oriented groups that shun Medicaid. Just a personal observation.