NY AG settles with Carelon over behavioral health 'ghost networks'
New York Attorney General Letitia James' office announced Nov. 10 that Carelon Behavioral Health will pay $2.35 million in penalties, fees and costs and up to $8 million in restitution under two settlements. The settlements resolve investigations into mental health "ghost networks" and improper denials of substance use disorder treatment. Restitution covers members who paid out of pocket for out-of-network mental healthcare after being unable to get an in-network appointment, members overcharged due to inaccurate provider listings, and members denied addiction treatment using criteria not approved by the state. Carelon administers behavioral health benefits for more than 4 million New Yorkers, with clients including EmblemHealth, Anthem Blue Cross Blue Shield, Independent Health and the Empire Plan, which covers state and local government employees. Under the settlements, Carelon must correct directory errors within two business days, verify provider data every 90 days, run quarterly secret shopper surveys, and meet appointment-timeliness standards, with an independent monitor reporting to the attorney general's office every six months.