BRUNSWICK — A Medicaid provider directory listed a Valdosta psychiatrist as available to patients. When PeachPol called the number provided, it was disconnected.
In Albany, some psychiatrists appeared repeatedly in search results, sometimes with different contact information. An OB/GYN listed by another health plan as not accepting new patients told PeachPol the office was accepting both that Medicaid plan and new patients.
And in some parts of South Georgia, searches for pediatric gastroenterologists and child psychiatrists turned up few options even when the search radius stretched well beyond the patient’s home community.
PeachPol reviewed provider directories for three of Georgia’s Medicaid managed-care plans — Amerigroup, CareSource and Peach State Health Plan — to see what patients looking for specialty care might actually encounter.
The review was not a comprehensive audit. But it found outdated or inconsistent information, disconnected phone numbers and listings that sometimes required additional calls to medical offices or health systems to determine whether the information was correct.
The findings come despite state requirements that Medicaid health plans regularly verify their provider information and update their online directories when changes occur.
The Georgia Department of Community Health, which oversees the plans, said outdated, duplicate or misclassified providers cannot be counted when determining whether a Medicaid plan has an adequate network.Screen capture of an Amerigroup provider search for pediatric gastroenterologists in Albany.
But neither the agency nor the health plans answered by PeachPol’s publication deadline whether any of the providers flagged during our reporting had been counted toward those network requirements.
In Brunswick, Amerigroup listed pediatric gastroenterology providers Abhishek Bhurwal, Temitope Foster and James Puleo through Southeast Georgia Physician Associates at 2415 Parkwood Drive.
PeachPol had difficulty reaching the providers through the directory information and sought additional confirmation about whether they treated pediatric gastroenterology patients.
For OB/GYN care in Brunswick, the office for Trace Deighan and Kristina Ericsson confirmed that it accepted Amerigroup and new patients, but PeachPol found discrepancies between the directory and the providers’ current practice information.
In Albany, child and adolescent psychiatrist Dan Phillips appeared repeatedly in Amerigroup search results. Smitha Battula also appeared multiple times with different contact information.
A large share of the psychiatry results in that search were tied to the same West Third Street location.
And in Valdosta, the phone number Amerigroup listed for psychiatrist Robert Maydell at Psychiatric Consulting Services of South Georgia was disconnected when PeachPol called.
Amerigroup said it investigated the specific listings PeachPol provided and confirmed participating providers who were accepting new patients, including children. It also said it verified several provider locations and contact details.
But the company acknowledged that it found some information that needed to be updated.
Amerigroup did not identify which listings required changes when PeachPol asked.
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The company said it conducts quarterly reviews of its provider directories and that providers are also responsible for verifying their information. Amerigroup said a provider can legitimately appear at multiple locations based on the provider’s Georgia Medicaid enrollment and that those listings do not necessarily affect how the company assesses network adequacy.
Some listings that initially appeared inconsistent turned out to be correct.
Peach State listed pediatric gastroenterologist Noel Israel at 1062 Forsyth St. in Macon. Another Medicaid plan listed Israel at a different Macon address with a different phone number.
Atrium Health Navicent Medical Center in Macon confirmed that Israel and pediatric gastroenterologist Elliott Gordon practice at both 1062 Forsyth St. and 777 Hemlock St. A third physician PeachPol checked, Sesi Dosunmu-Ogunbi, remains employed by Atrium and provides care virtually on an as-needed basis.
Atrium said it sends health plans monthly updates about provider additions, changes and departures. The individual health plans are responsible for maintaining their own directories.
The reporting also showed that accurate listings do not always mean nearby care is easy to find.
A Peach State search from one South Georgia market returned only two pediatric gastroenterology results within a 150-mile search area. That means a child seeking treatment for conditions such as Celiac disease, issues with malnutrition and Crohn’s Disease would have to travel hours to see a specialist.
Searches for child and adolescent psychiatrists in Albany, Brunswick and Valdosta also produced limited options even after the search radius was expanded.
In Albany, Peach State listed OB/GYN Kelly Albrecht as not accepting new patients. The medical office told PeachPol that Albrecht accepted Peach State Medicaid and was accepting new patients.
Peach State did not answer by publication whether that listing was inaccurate, whether it had been corrected or whether any of the providers PeachPol flagged were counted toward the plan’s network-adequacy calculations.Screen capture of a Peach State Health Plan provider search for OB/GYNs in Brunswick.
In a statement, Peach State said it regularly reviews provider network and directory information using provider rosters, state data, third-party validation and direct outreach.
The plan said providers are required to notify Peach State of changes and that it updates directory information as changes are verified.
Peach State also said it evaluates provider availability and geographic access and reports identified gaps to DCH.
“If a member is unable to find an available specialist within a reasonable distance, Peach State Health Plan will work directly with the member to identify an appropriate option,” the company said.
That can include another participating provider or a member-specific arrangement, according to the statement.
The state requires Medicaid managed-care plans to validate provider demographic information at least quarterly, according to DCH.
The agency said plans must update electronic provider directories no later than 30 days after receiving updated provider information. Online directories also must be updated within five business days after certain changes in provider networks, whether a provider is accepting patients or what services a provider offers.
The directories are required to include information such as provider locations, phone numbers, office hours, specialties, whether the provider is accepting new patients, languages spoken and accommodations for people with physical disabilities.
DCH said it reviews a sample of providers quarterly through network-adequacy reviews and secret-shopper calls.
The agency also said duplicate, outdated or misclassified listings cannot count toward network-adequacy requirements.
When problems are found, DCH said it can work directly with a managed-care organization to correct the deficiency, issue a corrective action plan or take other enforcement action.
DCH confirmed that it recently issued a corrective action plan to CareSource involving its provider network.
The agency did not provide the corrective action plan by PeachPol’s publication deadline or answer follow-up questions about what prompted it, whether directory inaccuracies played a role or whether the corrective action remained open.
CareSource said in a statement that it is focused on ensuring members can access care and on providing accurate information to help them make those decisions.
The company did not provide additional information before publication about the specific listings PeachPol identified.Screen capture of a CareSource provider search for pediatric psychiatrists in Valdosta
PeachPol also asked DCH and the health plans whether any of the providers flagged during the reporting were included in recent network-adequacy calculations.
None answered that question by publication deadline.
That leaves an important distinction unresolved.
A directory can contain outdated information even if a health plan still has enough providers to meet state access standards. And a directory can be accurate while showing that a specialist is simply difficult to find nearby.
But for patients, those problems can feel the same.
A provider may be listed several times. A phone number may not work. A doctor may be listed at the wrong location or with incorrect information about whether new patients are being accepted.
And in areas where specialists are already limited, each bad lead can mean another call, another search or another long drive.
Providers, health systems, insurers and the state all have roles in keeping directory information current.
But patients are the ones relying on those listings when they need care.
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