MVP Health Care fined for its website's inaccurate mental health directory

SCHENECTADY -- A Schenectady-based health insurance company will pay more than $250,000 in damages and restitution following an investigation by the state's Attorney General's Office that found inaccurate information relating to in-network mental health providers listed on its website.

MVP Health Care agreed to the settlement after a "secret shopper survey" conducted by the Attorney General's Health Care Bureau beginning in 2023 "uncovered systemic issues" with the insurance company's mental health provider directory that may have left some patients unable to access care or pay out-of-pocket for services.

"New Yorkers seeking mental health care deserve timely, accurate information," Attorney General Letitia James said in a statement. "When families turn to their health plans for help, they should be able to trust that the information they are given is reliable, and that they can access care without unnecessary obstacles.

Investigators posed as family members of a person with a mental health condition and sought an appointment with 24 mental health providers listed on MVP's directory that were said to be taking new patients.

But investigators found that the providers -- which have offices listed in Albany, Schenectady and Columbia counties -- were either unreachable, not accepting new patients or not in-network, despite being listed as such.

Seven of the companies contacted did not work out of the listed location. Seven others were not accepting new patients, with six others had non-working or incorrect numbers or did not return calls seeking appointments, according to a https://ag.ny.gov/sites/default/files/settlements-agreements/mvp-he lth-plan-inc-assurance-of-discontinuance-2025.pdf settlement agreement outlining the investigation.

Investigators were unable to make an appointment with any of the mental health providers contacted.

MVP is not the only health insurance provider with so-called "ghost networks" listed on its directory.

A https://ag.ny.gov/sites/default/files/reports/mental-health-report_ .pdf 2023 report by the state Attorney General found that a secret shopper investigation of 13 health plans resulted in hundreds of ghost networks, when a provider listed did not result in an appointment.

Of the 396 mental health providers contacted for an appointment, just 56, or 14%, resulted in an actual appointment, according to the report.

"The process of navigating a health plan provider directory filled with ghosts is confusing, time-consuming, and often ends in frustration," the report reads. "Expending a great deal of time and effort trying to find an in-network provider in a directory that is 86 percent inaccurate undoubtedly has a negative impact on a person suffering from a mental health condition."

The report found that 3 million New Yorkers live with a mental health condition and that one-third are not treated.

"Academic research suggests that insurers' failure to ensure that their mental health provider directories are accurate -- and to maintain adequate mental health networks -- has exacerbated the mental health crisis," the report reads.

As part of the settlement, MVP Health Care will be required to pay a $250,000 in penalties and fees and costs to the state, and much pay restitution to patients who paid in excess of any applicable in-network fees with providers incorrectly listed in its directory dating back to Jan. 1, 2020 through the effective date of the agreement.

In addition, the health insurance company -- which has 328,175 members -- will also be required to overhaul its provider directory to ensure all mental health providers listed are in-network, accepting new patients and can be reached via the information listed. The company will also be required to update the registry within 15 days of receiving new information and will be required to remove providers who fail to respond to verification requests.

MVP will also be required to reach out to each provider in its network every 90 days to confirm their participation. The insurance company has also committed to making "new and meaningful investments" to its mental health provider network, recruiting additional psychiatrists and psychiatric nurse practitioners who treat children and adolescents.

In a statement, MVP Health Care said it is committed to "delivering a health care experience that our members can trust," including mental health services.

"We know that demand for mental health care continues to grow, and connecting members to the right care requires innovative solutions and strong partnerships to overcome provider shortage challenges," the state reads. "That's why we are investing in provider recruitment into our network, expanding virtual care options, and improving the systems that help members find and schedule appointments quickly and confidently."