What GAO Found Limitations in control activities allowed potentially ineligible providers to participate in the Federal Employees Health Benefits (FEHB) program. The Office of Personnel Management (OPM) and its Office of the Inspector General (OIG) have a variety of control activities for identifying ineligible providers. However, GAO found limitations in these control activities. GAO’s data analyses identified FEHB claims from approximately 400 providers who were deceased and over 2,000 additional claims from providers who were excluded from federal programs. While such claims are a small proportion of annual FEHB claims, they represent a risk the agency could mitigate. Taking additional steps to identify providers who are deceased or excluded from other federal programs would help OPM and OPM OIG prevent fraud and improper payments in the FEHB program. For example, comparing death data with FEHB claims could help prevent improper payments or fraud in FEHB claims payments. Selected FEHB carriers do not always comply with requirements for identifying and excluding suspended or debarred providers. GAO found that selected FEHB carriers—which operate health benefit plans—do not always notify patients that their providers are suspended or debarred, as required. Carriers also did not notify OPM OIG when providers may warrant suspension or…
Professional
Federal Employees Health Benefits Program: Additional Actions Needed to Address Significant Risks in Verifying Provider Eligibility
Source: US GAO Reports — US Government, Public Domain