Ghost network

Ghost network refers to a form of healthcare insurance fraud where providers are listed as in a health insurance plan, but are unable to provide care. These ghost providers may no longer be eligible to practice, may have retired, may no longer accept new patients, may not actually part of the network, or may not exist. The inclusion of ghost providers may be intentional to exaggerate plan availability to encourage enrollment and falsely meet healthcare network adequacy.[1]

Ghost networks can negatively affect the quality of service received by plan participants and the delayed care may negatively impact patients.[2]

United States

Health insurance carriers may decline to make up-to-date directories of participating providers available online, and instead mail directories to delay and decrease utilization.[3] Network accuracy is not enforced at the federal level, but several states have passed legislation to address the issue.[4][5]

Ghost networks are prevalent for mental health providers in the US.[6]

References

1. Blau, Max (September 22, 2024). "Up against a 'ghost network' for mental health care? Here's what you can do". NPR. Retrieved 22 September 2024.
2. O'Connor, Katie (1 July 2023). "'Ghost Networks' Put Patients at Risk of Becoming More Ill". Psychiatric News. 58 (7). doi:10.1176/appi.pn.2023.07.7.10.
3. Blau, Max (September 22, 2024). "'I Don't Want to Die.' He needed mental health care. He found a ghost network". NPR. Retrieved 22 September 2024.
4. Rahim, Hannah (December 6, 2023). "Addressing Ghost Networks in Mental Health Care". Bill of Health. Petrie-Flom Center. Harvard Law School. Retrieved 22 September 2024.
5. Yarrow, Grace (May 4, 2023). "Congress urged to tackle 'ghost networks' amid mental health crisis". The Hill. Retrieved 22 September 2024.
6. Melillo, Gianna (September 24, 2023). "Ghost Network Busters". Managed Healthcare Executive. 33 (9).