Study Indicates Insurers Inflate Medicaid Physician Networks

Insurers may be artificially padding their Medicaid physician networks, according to a study published in Health Affairs. The authors found that 16% of primary care physicians in Medicaid managed care networks did not file any Medicaid claims, and a third filed less than ten claims in the same period. Some insurers, according to the study, may be filling their networks with physicians that won’t accept Medicaid beneficiaries, despite being in-network.

According to Susan Kelly, ”The findings showed a small set of physicians provided most of the care to Medicaid beneficiaries. A quarter of primary care physicians provided 86% of the care, and a quarter of specialists provided 75% of the care for Medicaid beneficiaries.”

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(Source: Healthcare Dive, May 3^rd, 2022)