Harvard Researchers Partner with HiLabs to Study Ghost Networks and Real-World Access to Care Across Medicare Advantage

HiLabs, Inc. and Dr. Thomas Tsai announce a multi-year research collaboration to measure true access to care and expose ghost networks affecting 35 million Medicare Advantage enrollees.

WASHINGTON, June 30, 2026 /PRNewswire/ -- For 35 million Americans enrolled in Medicare Advantage, finding a doctor should not be the hardest part of getting care. Yet for millions of beneficiaries, provider directories that look complete on paper mask a different reality: providers who are unreachable, no longer participating, or not accepting new patients. These are ghost networks, and they represent one of the most consequential and least examined failures in American healthcare today.

HiLabs, a leading healthcare data intelligence company whose work directly supports health plans in meeting CMS network adequacy standards and federal directory accuracy requirements, announced today a multi-year research collaboration with Dr. Thomas Tsai, Associate Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and Associate Professor of Surgery at Harvard Medical School, to study provider network adequacy and ghost networks in Medicare Advantage.

Eliminating ghost networks and delivering true network adequacy has been at the core of HiLabs' mission since its founding. Five of the nation's ten largest health plans and dozens of regional carriers rely on HiLabs' MCheck^® Provider suite to move beyond paper compliance and know, in real time, what their network can actually deliver for members.

Processing hundreds of millions of provider records and continuously validating provider availability across thousands of data sources has given HiLabs an unmatched operational view into where ghost networks are most severe and what it takes to close the gap. Most recently, a leading national behavioral health plan selected HiLabs to achieve true network adequacy across its network, demonstrating the operational impact of this approach at scale. This research collaboration extends that mission into the scientific domain, contributing real-world provider data and AI-powered ghost network detection to help independent researchers measure the problem at a national scale for the first time.

The collaboration will examine how ghost networks affect access to care for Medicare Advantage enrollees, evaluate how practitioners measure and experience network adequacy in practice, and assess what the gap between listed and accessible providers means for patient outcomes. Medicare Advantage network adequacy is under intensifying federal scrutiny. CMS audits are increasingly focused on the gap between what provider directories list and what members can actually access. 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. At the moment it is most needed.

"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. Thomas Tsai. "This collaboration will allow the Healthcare Quality and Outcomes Lab to conduct cutting-edge research to ensure Medicare beneficiaries are able to access the care they need under private Medicare Advantage health plans."

The findings will give health plan leaders, CMS, URAC, and state insurance regulators the clearest independent picture yet of where the gap between listed and accessible providers is most acute, and what it costs the millions of beneficiaries whose access to care depends on the accuracy of those networks.

"Network adequacy is foundational for healthcare access. Patients must be able to connect with their doctors, and 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," said Amit Garg, CEO and co-founder of HiLabs. "We are proud to support Dr. Tsai's critical research with the data and AI capabilities needed to understand how provider networks function in the real world."

The research collaboration is expected to extend over multiple years. Findings will be disseminated through appropriate research and academic channels as the work advances. For health plan leaders whose network strategy rests on the assumption that listed is the same as available, this research will be difficult to ignore.

About HiLabs, Inc.

HiLabs, Inc. is a healthcare AI company focused on solving the most complex challenges in health plan data, outreach, and operations. Its MCheck^® platform suite is deployed by leading national and regional health plans to improve provider data accuracy, streamline compliance workflows, and fundamentally reduce the cost of operating at scale. Built with deep healthcare domain expertise, HiLabs combines applied AI with operational intelligence to deliver measurable, production-grade outcomes across high-impact workflows. The result is infrastructure that enables health plans to operate with precision, maintain audit-ready data, and meet rising regulatory demands with confidence. For more information, visit www.hilabs.com or contact us.

About Dr. Thomas Tsai

Thomas Tsai, MD, MPH, is an Associate Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and an Associate Professor of Surgery at Harvard Medical School. He serves as the Medical Director for Health Policy Research for the American College of Surgeons and is a practicing surgeon at Mass General Brigham. His research focuses on healthcare delivery, access to care, and the impact of policy and organizational structures on patient outcomes.

Media Contact: [email protected]

Logo: https://mma.prnewswire.com/media/2955868/HiLabs_Logo.jpg

SOURCE HiLabs