Harvard and HiLabs Target the 'Ghost Networks' Plaguing Medicare Advantage

WASHINGTON, June 30, 2026 – For 35 million Americans enrolled in private Medicare Advantage plans, the provider directory is supposed to be a roadmap to care. But for a growing number, it's a map to nowhere. A new multi-year research collaboration between Harvard researchers and healthcare AI firm HiLabs aims to expose the scale of this problem, leveraging advanced data intelligence to quantify the impact of “ghost networks” on a national scale for the first time.

The partnership brings together Dr. Thomas Tsai, a surgeon and health policy expert at the Harvard T.H. Chan School of Public Health, with HiLabs, a company whose technology is already used by major health plans to clean up the data that fuels these phantom directories. The goal is to move beyond anecdotal evidence and create an independent, data-driven picture of a systemic failure that directly impedes access to care for the elderly and disabled.

The Human Cost of a Systemic Failure

Ghost networks are the healthcare equivalent of a mirage. They are provider directories that appear robust on paper but are riddled with inaccuracies. These phantom listings include doctors who have retired, moved, or are no longer in the plan's network. More commonly, they list providers who are technically in-network but are not accepting new patients or have multi-month wait times, rendering them inaccessible in practice. The result is a frustrating and often costly dead end for patients.

"For older adults and people with long-term disabilities enrolled in Medicare Advantage, a ghost provider is not an inconvenience, it is a barrier to care," the initial announcement stated. This barrier has tangible consequences. Government Accountability Office (GAO) reports have previously highlighted beneficiary complaints about access, and consumer advocates frequently report stories of patients spending weeks making dozens of calls, only to find no available in-network care, particularly for mental health services.

This can lead to dangerous delays in treatment or force patients to either pay steep out-of-pocket costs for an out-of-network provider or abandon their search for care altogether. One study found that patients misled by inaccurate directories were four times more likely to receive a surprise out-of-network bill. The problem is so pervasive that it has drawn increasing fire from federal regulators, who see the gap between listed and available providers as a critical failure in oversight.

Beyond Paper Compliance: The Rise of Data-Driven Oversight

The persistence of ghost networks highlights a fundamental flaw in the traditional approach to compliance, which often relies on self-attestation from health plans. HiLabs argues that the solution lies in a strategic shift toward active, AI-driven data validation. This is where the company's MCheck® platform comes in, representing a new front in the battle for operational integrity.

"Network adequacy is foundational for healthcare access," said Amit Garg, CEO and co-founder of HiLabs. "That starts with dependable networks, not just directories that appear complete on paper, but networks that are continuously validated to reflect who is genuinely available to members."

HiLabs' technology processes hundreds of millions of provider records, cross-referencing them against thousands of public and private data sources in near real-time. By applying AI to detect discrepancies in over 60 data elements—from phone numbers and addresses to specialty and patient acceptance status—the platform aims to replace static, error-prone lists with a dynamic, audit-ready source of truth. This approach, already in use by five of the nation's ten largest health plans, treats data integrity not as a back-office chore but as a core strategic asset essential for both regulatory compliance and member trust.

This collaboration extends that operational mission into the scientific domain. By providing Dr. Tsai’s team with its real-world data and AI-powered detection capabilities, HiLabs is enabling independent researchers to measure the problem with a precision previously unavailable to academia or regulators.

A New Era of Accountability for Medicare Advantage?

The timing of this research is critical. Medicare Advantage is under an intensifying federal microscope. The Centers for Medicare & Medicaid Services (CMS) has signaled its intent to tighten oversight, with audits increasingly focused on the real-world accessibility of providers. Reports from the GAO and the Office of Inspector General (OIG) have repeatedly flagged significant issues, from improper care denials to the very ghost network problem this research targets.

Pairing a prestigious academic institution like Harvard with an industry data-science leader creates a powerful engine for accountability. The research, led by Dr. Tsai's Healthcare Quality and Outcomes Lab, will not only measure the prevalence of ghost networks but also assess their direct impact on patient outcomes.

"As more Medicare beneficiaries elect to enroll in Medicare Advantage, federal policymakers should evaluate whether beneficiaries can access a diverse array of high-quality physicians, hospitals, and other healthcare facilities necessary to achieve optimal health outcomes," said Dr. Tsai. He noted the collaboration will enable "cutting-edge research to ensure Medicare beneficiaries are able to access the care they need."

The findings are expected to provide the clearest independent picture yet of where the gaps between promise and reality are most acute. For health plan leaders, regulators at CMS and URAC, and state insurance commissioners, the multi-year study promises to deliver a dataset that will be difficult to ignore, potentially reshaping network adequacy standards and enforcement for years to come.