Ghost network refers to a form of healthcareinsurance 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]
^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.
This article needs additional or more specific categories. Please help out by adding categories to it so that it can be listed with similar articles.(September 2024)
