GAO said that OPM does not have an estimate of how many ineligible persons are covered. Image: sasirin pamai/Shutterstock.com
By: FEDweek StaffIn the type of letter that promises to become common in this Congress, the chair of the House Oversight and Accountability Committee has pressed OPM to respond to the recent GAO report on ineligible persons being enrolled as family members in the FEHB.
“This is a flagrant waste of funds and may be driving up premium costs for eligible participants. The Committee seeks documents and information to understand how these improper payments were allowed to happen, and what OPM is doing to fix this problem moving forward,” Rep. James Comer, R-Ky., wrote to OPM.
The report followed several of recent years from the inspector general’s office at OPM raising the same issue regarding the $59 billion a year program in which some 4.1 million enrollees—about an equal number of family members also are covered—pay about 30 percent of the total premium cost and the government pays 70 percent. GAO said that OPM does not have an estimate of how many ineligible persons are covered, and officials of several employing offices and insurance carriers told GAO that they take only limited steps to identify and remove them.
Wrote Comer, “GAO’s report suggests OPM has been aware of this problem for years but has consistently failed to address it effectively. As GAO recounts, OPM acknowledged the possibility of a problem when it issued regulations in 2018 allowing agencies and participating insurers to request proof of eligibility for federal employees’ family members. OPM did not, however, actually require proof of eligibility.
“Three years later, OPM issued verification requirements for “certain types” of new enrollments, but left other new enrollments and all pre-existing enrollments out of this verification regime. To this day, according to GAO, ‘OPM does not plan to establish a monitoring mechanism to identify and remove ineligible family members who already have FEHB coverage.’”
GAO cited an OPM estimate of the potential for up to $1 billion in additional costs. Comer said that “it is entirely possible OPM’s failure has led to several tens of billions of dollars in waste, fraud and abuse over the program’s 60-plus year existence.”
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