Harvard and HiLabs Partner to Expose Medicare Advantage Ghost Networks

The initiative seeks to move beyond paper compliance by applying AI-powered detection to real-world provider data. While health plans often meet federal directory requirements on paper, the gap between these lists and actual appointment availability remains a significant hurdle for patients seeking care. Dr. Thomas Tsai, who leads the Healthcare Quality and Outcomes Lab, plans to evaluate how these discrepancies influence patient outcomes and access for older adults and those with long-term disabilities.

HiLabs will provide the technological backbone for this study, utilizing its MCheck platform to process hundreds of millions of provider records. By integrating this intelligence into academic research, the team intends to provide CMS, state regulators, and health plan leaders with an independent, data-driven assessment of network adequacy. The findings are expected to pressure the industry to align directory accuracy with the clinical reality of patient care, shifting the focus from administrative reporting to functional access.