Moda Health, Samaritan Health Services Called Out by CMS

Two Medicare Advantage plans in Oregon could face heavy fines or have to stop enrolling people because of high rates of errors in their online network directories.

Moda Health and Samaritan Health Services are among 21 insurers across the country that received warning letters from the Center for Medicare & Medicaid Services recently. Those letters were sent Jan. 6, and the health plans have until Feb. 6 to resolve the problems.

A 2016 audit of its provider directory produced some poor results, Jonathan Nicholas, vice president at Moda Health, told The Lund Report. “

A 2016 audit of our provider list indicated some directory inaccuracies and we moved immediately to fix the specific errors that were identified. We now have in place an ongoing work plan to fine-tune our processes to better maintain directory accuracy.  This includes outreach to our provider community to ensure that we have the most accurate and up to date information. In addition, we are engaging a third-party data vendor to alert us going forward to changes in provider data and status."

Samaritan is also aware of the concerns raised by CMS about its provider directory and is working to resolve their concerns, according to Kelley Kaiser, MPH, chief executive officer.

According to an article that appeared in Kaiser Health News, consumers and advocates have been complaining about the accuracy of Medicare Advantage provider directories for years.

“Because Medicare Advantage members rely on provider directories to locate an in-network provider, these inaccuracies pose a significant access-to-care barrier,” according to the article. Medicare officials wrote in a report released last week outlining the problems.

In conducting the review, federal officials focused on primary care doctors, cardiologists, ophthalmologists and oncologists, calling those physicians.

“We encountered several instances where a call to a provider’s office resulted in determining that the provider had been retired or deceased for a long period of time, sometimes years,” the report said.

In the directories, nearly half of the 5,832 doctors listed in those 21 Medicare Advantage plans had incorrect information, including wrong addresses and wrong phone numbers. “We saw a general lack of internal audit and testing of directory accuracy among many” Medicare Advantage organizations, the report said.

Medicare Advantage members have until Feb. 14 to dis-enroll and join traditional Medicare.

Diane can be reached at [email protected]. .