A report from the Government Accountability Office (GAO) released Jan. 9 indicates that due to a lack of information about the number of ineligible family members receiving payments, the Federal Employees Health Benefits (FEHB) program could be wasting nearly $1 billion each year.
The GAO says that while in 2021 the Office of Personnel Management (OPM) began requiring some new program enrollees to verify that their family members are eligible, the agency doesn’t have a process to identify and remove ineligible family members who are already enrolled in the program.
“Until OPM assesses the likelihood and impact from the fraud risk of ineligible FEHB members and documents that assessment, it cannot support its determination that the program is at a low risk of fraud,” the GAO wrote. “As a result, the program may remain vulnerable to the fraud risk associated with ineligible members.”
The report identifies the extent to which:
(1) OPM has implemented control activities to identify and remove ineligible family members with FEHB coverage and
(2) OPM’s fraud risk assessment for the FEHB program includes fraud risks related to ineligible FEHB members.
The GAO is making four recommendations to OPM, including that it implement a monitoring mechanism to identify and remove ineligible family members from the FEHB program and assess and document the likelihood and impact of fraud risks associated with ineligible FEHB members.
OPM generally agreed with the recommendations, according to the GAO.
A summary of the recommendations is below:
More than 8 million federal employees, retirees and their families receive health insurance benefits under FEHB.
To read the full GAO report, go here.