By skyforbes 
Centene Corporation, the largest provider of Medicaid managed care in the United States, has been the subject of repeated regulatory findings involving inaccurate provider directories. These directories are required by federal and state contracts to reflect the actual doctors, specialists, and facilities available to Medicaid enrollees. In several states, investigations have revealed substantial errors, including outdated listings, unreachable phone numbers, and medical offices that were not in operation.
California: Health Net Audit
In 2022, the California Department of Managed Health Care conducted a routine audit of Health Net, a Centene subsidiary. It found that 45.1% of the listed provider information in the directory was inaccurate. The problems included:
- Providers who were no longer practicing
- Offices that had closed
- Phone numbers that were disconnected
- Facilities not accepting new patients, despite being listed as available
These inaccuracies were determined to affect both access and adequacy calculations under state rules. California imposed penalties and required a corrective action plan.
New Mexico: Western Sky Community Care
New Mexico regulators found similar issues in 2023 during an evaluation of Western Sky Community Care, another Centene-owned Medicaid plan. The audit identified several deficiencies in provider access, including:
- Offices that could not be located at the listed address
- Clinics with incorrect or non-functional contact information
- Providers listed as in-network who were not actively seeing Medicaid patients
The New Mexico Human Services Department directed the company to revise its reporting systems and correct the discrepancies.
Ohio and Other States
In Ohio, Centene was among several managed care companies flagged for discrepancies between submitted provider data and actual service availability. The state ordered the plans to improve data quality and conduct outreach to verify information.
Although detailed enforcement actions have not always been made public, records show that Centene has faced similar provider directory issues in Texas, Florida, and Illinois. These have typically resulted in mandated compliance improvements or audit follow-ups.
Federal Oversight Gaps
Under federal law, Medicaid managed care organizations must maintain provider directories that are complete and accurate. The Centers for Medicare & Medicaid Services (CMS) has issued guidance requiring updates at least quarterly. Directories must include the provider’s name, specialty, location, phone number, and whether the provider is accepting new patients.
Despite these requirements, CMS does not consistently audit these directories. Enforcement is largely left to individual states, resulting in wide variation in accuracy, oversight, and consequences.
Government Accountability Office Findings
In 2022, the U.S. Government Accountability Office (GAO) released a report (GAO-22–104480) examining Medicaid access across several states. The report found that inaccuracies in provider directories were widespread and affected patients’ ability to receive timely care. The GAO cited Centene among the companies with reported compliance issues, though the report covered multiple insurers.
The GAO recommended increased federal oversight and standardized auditing procedures, but no national requirement has been implemented as of 2025.
Business Incentives and Public Impact
Maintaining a broad network is a key requirement for Medicaid plan contracts. Companies may benefit from listing more providers than are actually available, as it strengthens their appearance of compliance and improves their competitive positioning during contract evaluations.
However, for patients, inaccurate listings can result in missed care, long wait times, or travel burdens. Medicaid patients are often limited in time, transportation, and flexibility. Directory errors compound these barriers.
Penalties vs. Profits
Centene’s Medicaid operations generated over 6 billion dollars in profit in 2024. In contrast, penalties for inaccurate provider listings have been minimal. For example, Health Net’s 1.5 million dollar fine in California, tied to multiple violations including directory errors, represented less than one-tenth of one percent of Centene’s total revenue.
In most cases, the consequences have involved required corrective actions rather than material fines or contract suspensions.
Conclusion
Provider directories are not a minor administrative detail. They are a required part of Medicaid managed care and directly impact whether patients can access medical services. When those directories are inaccurate, and when errors are widespread, it becomes a structural failure.
Centene has been found, by multiple state agencies, to have submitted inaccurate directories across several of its Medicaid plans. These findings span years and cross state lines.
While regulators have taken steps to address these problems, enforcement remains inconsistent and financial penalties remain limited. Without stronger oversight and accountability, Medicaid patients will continue to face the consequences of a system that often fails to meet its basic obligations.