Ghost network refers to a form of healthcare insurance fraud where providers are listed as in a health insurance plan, but are unable to provide care. These ghost providers may no longer be eligible to practice, may have retired, may no longer accept new patients, may not actually part of the network, or may not exist. The inclusion of ghost providers may be intentional to exaggerate plan availability to encourage enrollment and falsely meet healthcare network adequacy.[1]
Ghost networks can negatively affect the quality of service received by plan participants and the delayed care may negatively impact patients.[2]