Another ghost network story is giving us chills.
A new whistleblower case reported in Modern Healthcare, alleges Aetna illegally secured contracts with Pennsylvania’s Medicaid program, HealthChoices, by misrepresenting the number of pediatricians in the plan’s network.
The former employee says she discovered that many of the pediatric providers assigned to the network were “not contracted with Aetna, dead, operating out of state or did not treat children at all.”
(To be totally clear, when we reference ghost networks, we’re usually talking networks that are out of date or inaccurate. Not ones with actually dead providers. That’s a bit too literal, even for us.)
We can neither confirm nor deny these haunting claims, but the case argues Aetna violated the False Claims Act and kept more cash, because kids couldn’t find doctors. Scary indeed.
Further, the employee says she brought her concerns before management, only to have one of her bosses tell her to pipe down. Then, she reports she was later fired following an “organizational review,” and that Aetna made no attempts to update their provider listings.
Aetna, of course, denies these allegations.
Ghost networks are not uncommon, and they are an unfortunate reality for many Medicaid subscribers. According to The Legal Reader, “By maintaining ghost networks, insurance companies with low-income contracts make it nearly impossible for [Medicaid patients] to receive the care they need.”