Provider directory accuracy
HHS OIG: 55% of listed Medicare Advantage behavioral health providers saw no patients
In 60 plans, more than half the behavioral health providers listed in Medicare Advantage directories treated no enrollees in 2023. Keeping a directory true is a goal with no finish line.
- HHS Office of Inspector General
of listed MA behavioral health providers saw no enrollees in 2023
HHS OIG report OEI-02-23-00540of inactive providers said they should not have been listed
HHS OIG report OEI-02-23-00540plans reviewed in 10 counties across 5 states
HHS OIG report OEI-02-23-00540What happened
The story, from the record.
In October 2025 the HHS Office of Inspector General published its review of behavioral health provider networks in 60 managed care plans: four Medicare Advantage and two Medicaid plans in each of ten counties across five states.
On average, 55% of the behavioral health providers listed in Medicare Advantage plan networks, and 28% of those in Medicaid plans, provided no services to the plan's enrollees in 2023. In 18 of the Medicare Advantage plans, more than 60% of listed providers were inactive. When OIG surveyed inactive providers, 72% said they should not have been listed at all: they were no longer at the listed location, or would not see the plan's enrollees.
Medicare Advantage plans had, on average, 16% of the county's behavioral health workforce in network, against 31% for Medicaid plans. OIG made three recommendations to CMS, which neither concurred nor non-concurred.
A directory listing is a claim about a person, an address and a willingness to take new patients. Each of those changes without notice. Re-verifying every listing, every quarter, by actually reaching the provider, is the work the audit describes and nobody is staffed for.
How OneShot would run it
The goal this leaves open.
OneShot was not involved in this event. This is how the goal it describes would run as one OneShot goal: the objective, the steps per case, and the list price of each.
Re-verify every behavioral health listing in a plan's directory every 90 days, by phone, and keep inaccurate listings below 10%.
- 01$0.0178
Check the license
Look the provider up in the national registry and the state licensing board, and confirm the practice still operates at the listed address.
- Browser
- Local Business Resolve
- Web Read
- 02$1.06
Call as a member would
Call the practice and ask for the next appointment for a plan member. Call analysis records whether they take the plan, take new patients, and how long the wait is.
- Voice call time
- Call analysis
- 03$0.01
Request an attestation
Email the practice a pre-filled attestation for the corrected listing and read the signed reply from the inbox; fax where that is all they accept.
- Email send
- Email Inbox
- FaxIn development
- 04$0.01
Fill the gap
Where a listing is dead, find licensed providers in the same county who are not in the network, and hand the list to contracting.
- Local Business Search
- People Discovery
- 05—
Correct and report
Push corrections to the directory and report accuracy by county each cycle, with a receipt for every call.
About $1.10 per case at list prices. Spend limits cap the run; every paid action returns a signed receipt; anything over your approval threshold waits for a person.
Sources
Where the figures come from.
- HHS OIG report OEI-02-23-00540checked Oct 3, 2026
