EmblemHealth will pay $2.5 million after investigation reveals 'ghost network' of providers

STATEWIDE — NEW YORK ATTORNEY GENERAL LETITIA JAMES ON THURSDAY, FEB. 19, SECURED MORE THAN $2.5 MILLION FROM HEALTH INSURER EMBLEMHEALTH (Emblem) after an investigation revealed the company repeatedly failed to ensure that New Yorkers could access mental health care services.

An Office of the Attorney General (OAG) investigation found that Emblem maintained inaccurate provider directories, overstated the availability of in-network mental health and substance use disorder providers, and failed to comply with state and federal behavioral health parity laws. Consequently, New Yorkers were unable to find timely, affordable care when they needed it most.

The OAG's 2023 investigation conducted a secret shopper survey of mental health and substance use disorder providers listed in the company's online directory and determined that more than 80% of surveyed behavioral health providers Emblem listed as accepting new patients were effectively unavailable, creating "ghost networks" of providers that exist on paper but not in reality. Emblem's own surveys showed similar results.

Under the settlement, Emblem will pay $2.5 million in penalties and fees, provide restitution to members who were forced to pay out of pocket for mental health care, and implement sweeping reforms to improve access to mental health and substance use disorder treatment.

✰✰✰

Subscribe to Continue Reading

Sign In