The Centers for Medicare & Medicaid Services (CMS) recently issued a wave of compliance actions against Medicare Advantage Organizations (MAOs) for failing to maintain accurate online provider directories. Prompted by complaints of deficiencies in the directories, CMS had undertaken a study to test the accuracy of information contained in them.
CMS's first review round, which studied 54 MAOs encompassing a total of 5,832 providers (representing 11,646 locations), found that over 45% of the provider directory locations studied were inaccurate. Additionally, nearly 47% of providers in the review had at least one deficiency. The types of errors identified included incorrect phone numbers, inaccurate listings of locations where providers offered services, and inaccuracies regarding whether or not providers were accepting new patients. These deficiencies appeared to result from group practices providing data at the group level rather than at a provider level, MAOs employing a reactive rather than a proactive approach to data integrity, and a general lack of internal audit and testing of the directory by MAOs.
The second review round, which will examine directories of an additional 64 MAOs, is currently in progress. Through its published report of the first review round and the resulting compliance actions, CMS has clearly communicated its expectation that MAOs will correct errors and proactively participate in maintaining the accuracy of provider directories. MAOs that fail to respond can expect additional compliance action by CMS which may include fines and sanctions.
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