# Ghost network

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{{Short description|Form of health insurance fraud}}

'''Ghost network''' refers to a form of [healthcare](/source/health_care_fraud) [insurance fraud](/source/insurance_fraud) in which a [health insurance](/source/health_insurance) plan lists [providers](/source/health_care_provider) who cannot provide care. The listed "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](/source/network_adequacy).<ref>{{cite news |last1=Blau |first1=Max |title=Up against a 'ghost network' for mental health care? Here's what you can do |url=https://www.npr.org/sections/shots-health-news/2024/09/20/nx-s1-5118420/mental-health-insurance-guide-ghost-network |access-date=22 September 2024 |work=NPR |date=September 22, 2024}}</ref>

Ghost networks can negatively affect the quality of service received by plan participants. The delayed care may negatively impact patients.<ref>{{cite journal |last1=O'Connor |first1=Katie |title='Ghost Networks' Put Patients at Risk of Becoming More Ill |journal=Psychiatric News |date=1 July 2023 |volume=58 |issue=7 |article-number=appi.pn.2023.07.7.10 |doi=10.1176/appi.pn.2023.07.7.10}}</ref>

==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.<ref name="Blau">{{cite news |last1=Blau |first1=Max |title='I Don't Want to Die.' He needed mental health care. He found a ghost network |url=https://www.npr.org/sections/shots-health-news/2024/09/21/nx-s1-5120543/mental-health-care-parity-insurance-ghost-network |access-date=22 September 2024 |work=NPR |date=September 22, 2024}}</ref> Network accuracy is not enforced at the federal level, but several states have passed legislation to address the issue.<ref name="Rahim">{{cite news |last1=Rahim |first1=Hannah |title=Addressing Ghost Networks in Mental Health Care |url=https://blog.petrieflom.law.harvard.edu/2023/12/06/addressing-ghost-networks-in-mental-health-care/ |access-date=22 September 2024 |work=Bill of Health |publisher=[Petrie-Flom Center](/source/Petrie-Flom_Center)|agency=[Harvard Law School](/source/Harvard_Law_School) |date=December 6, 2023}}</ref><ref>{{cite news |last1=Yarrow |first1=Grace |title=Congress urged to tackle 'ghost networks' amid mental health crisis |url=https://thehill.com/policy/healthcare/3988563-congress-urged-tackle-ghost-networks-amid-mental-health-crisis/ |access-date=22 September 2024 |work=The Hill |date=May 4, 2023}}</ref>

Ghost networks are prevalent for mental health providers in the US.<ref name="Melillo">{{cite journal |last1=Melillo |first1=Gianna |title=Ghost Network Busters |journal=Managed Healthcare Executive |date=September 24, 2023 |volume=33 |issue=9 |url=https://www.managedhealthcareexecutive.com/view/ghost-network-busters}}</ref>

==References==
{{Reflist}}

{{Fraud}}

Category:Healthcare in the United States
Category:Insurance fraud

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Adapted from the Wikipedia article [Ghost network](https://en.wikipedia.org/wiki/Ghost_network) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Ghost_network?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.