Ninety percent of California health plans reviewed by the state did not accurately report which physicians were in-network in 2015, Kaiser Health News reported Monday.
The California Department of Managed Health Care report found 36 of 40 health plans submitted inaccurate data or did not follow proper reporting methodology. "The data submitted by health plans for 2015 contains so many errors that it is virtually impossible to draw conclusions regarding individual health plan compliance and performance across the industry," the DMHC report reads.
Payers were required to submit a compliance report to identify provider availability as well as a roster of all providers at the end of 2014. The reports are supposed to be fairly consistent, though some discrepancies may occur if providers leave or join the network.
The report from DMHC shows major discrepancies between these two lists for many payers. For example, UnitedHealthcare of California's primary care physician compliance report differed from its roster by 45 percent and Anthem and Cigna's PCP reports were both off by 36 percent, according to the report. The payers' specialist reports were even worse. UnitedHealthcare's specialist compliance report differed from its roster by 69 percent. Anthem and Cigna were off by 32 percent and 26 percent, respectively.
However, one payer specifically was called out by DMHC for significantly overinflating data. Aetna Health of California reported its specialist network included more than 30,000 cardiologists, dermatologists and allergists — a number three times higher than its peers. Further investigation showed Aetna counted some cardiologists more than 160 times, according to the report.
Read the full report from DMHC here and the Kaiser Health News report here.
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