This article by Karen Jowers originally appeared on Military Times, the nation's largest independent newsroom dedicated to covering the military and veteran community.

The vast majority of listings for behavioral health providers in Tricare’s online directories may be inaccurate, hampering military families’ access to mental health care, government auditors said in a report published Monday.

The Government Accountability Office concluded that around 8 in 10 of those listings could be incorrect after posing as Tricare beneficiaries on hundreds of covert calls to providers. The watchdog agency encountered a host of problems with the directories, from faulty contact information to incorrectly showing whether a provider is taking new Tricare patients.

Finding behavioral health care services to treat mental health conditions and substance use disorders is already difficult for military beneficiaries amid a nationwide shortage of therapists and psychiatrists. Flawed directories compound the unique challenges facing military families, who rely on the listings to find care and have long complained about directory shortcomings. Frequent moves exacerbate the problem.

To help remedy the issue, GAO recommended that the Defense Health Agency specifically monitor the accuracy of behavioral health listings in the Tricare network, in addition to the agency’s broader checks of the directory overall.

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“Access to behavioral health care is paramount for Tricare beneficiaries, as demand for these services [has] increased among active duty service members and their families,” auditors said in the report.

More than 9 million Tricare beneficiaries receive care at military facilities, or through networks of civilian providers in two regions, Tricare East and West. Contractors in each region manage online provider directories spanning more than 1 million listings of health providers and specialists; the contractors are required to ensure listings are accurate and audit a portion of them each month. Defense health officials monitor the findings of those audits.

Congress mandated a GAO investigation in 2022 amid ongoing complaints about the quality of the directories. GAO dug into a fraction of the nearly 130,000 listings for behavioral health providers — with lackluster results.

The watchdog called a random sample of 342 behavioral health providers in the Tricare directories in July and August 2023, the report said. That was enough to estimate that 85% of nearly 61,000 such listings in Tricare East were inaccurate, and 79% of nearly 68,000 listings in Tricare West had errors, GAO said.

A listing was considered accurate if each of the elements required by the Pentagon were correct: a provider’s name, gender, specialty, sub-specialty, address, phone number and fax number. Auditors estimated that about 19% of all behavioral health listings in Tricare East, and about 22% of those listings in Tricare West, show a disconnected phone number or outdated address.

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The study also considered whether providers were accepting new Tricare patients. Of the listings GAO contacted that advertised accepting new Tricare patients, the watchdog found that only a small percentage actually were — 34% of those in Tricare East; and 19% of those in Tricare West.

DHA and Tricare’s contractors have tried to encourage health providers to accept more Tricare patients. But providers can be reluctant to accept Tricare because they want to avoid the system’s low reimbursement rates for services provided, a lack of awareness of the Tricare system, a preference for private insurance or avoiding insurance altogether, or burnout.

As part of its research, GAO also met with organizations representing Tricare beneficiaries and behavioral health providers, and interviewed defense officials and representatives from the two regional contractors.

Health Net Federal Services, the Tricare West contractor, argues that more than 8 in 10 of its listings across all providers are accurate.

The contractor told Military Times it “proactively works with our network providers to obtain timely, accurate directory data.”

“HNFS conducts monthly audits on a randomly selected, statistically valid sample of provider records, including those for behavioral health providers,” the company said.

Health Net said GAO hasn’t provided details of which listings it audited so the company can try to replicate its findings.

Officials with Humana Government Business, the Tricare East contractor, didn’t immediately respond to a request for comment.

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Karen Ruedisueli, director of government relations for health affairs for the Military Officers Association of America, said the advocacy group is “not at all surprised” by the findings.

“They validate beneficiary complaints we have heard for years about ‘ghost directories,’” Ruedisueli told Military Times. “Military families face so many challenges. Those reaching out for help should not have to slog through dozens of inaccurate listings to find a mental health provider.”

A recent survey conducted by the Military Family Advisory Network found that about 28% of actively serving families who sought out mental health care reported obstacles in getting appointments.

That comes amid a spike in the need for those services. Service members experienced a fourfold increase in mental health diagnoses from 2005 to 2021, according to the Defense Health Board, an independent committee that advises the defense secretary. Military children saw a sixfold increase in mental health diagnoses.

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Struggles to keep provider directories accurate are not unique to the military health system; state and federal laws and regulations designed to curb the problem have fallen short of that goal.

The Defense Health Agency, which manages Tricare, said multiple factors likely cause listing inaccuracies. Behavioral health providers are more mobile than others, the agency said, and may lack the administrative staff to update those details. DHA added that provider availability can change daily, and that some don’t post phone numbers because they prefer patients contact them by email or text.

Responding to GAO’s findings, DHA said it would look into how feasible it may be to require Tricare contractors to audit behavioral health listings as well as the directories at large, and agreed to address what could be causing possibly significant differences in the accuracies of behavioral health listings compared to Tricare providers overall.

While GAO said the contractors contend their overall accuracy rate hovers around 82%, auditors estimate just 15% of behavioral health listings are right in Tricare East and 21% in Tricare West.

Defense Health Agency officials pushed back on the report’s recommendation to ensure those rates are consistent, pointing to differences in the providers’ resources and how they conduct business.

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Defense officials also disagreed with the GAO recommendation that they periodically monitor the accuracy of the behavioral health provider listings in relation to the overall directory.

Tricare’s current contracts, as well as a new pair set to take effect in January, don’t require the network managers to audit individual specialties. Doing so would require more money, DHA Director Army Lt. Gen. Telita Crosland wrote in a response to GAO.

The agency itself also lacks the manpower to sufficiently pore over provider directories, Crosland said.

GAO maintains that the Pentagon should check Tricare’s behavioral health provider listings “to help ensure that beneficiaries have the best information available when they need to access behavioral health care.”

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