Private Medicare, Medicaid plans exaggerate in-network mental health options, watchdogs say [View all]
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/
Link to HHS OIG REPORT (PDF) - https://oig.hhs.gov/documents/evaluation/11233/OEI-02-23-00540.pdf
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