Fedweek

The FEDVIP vision-dental insurance program “is vulnerable to ineligible family members enrolling in the program with increased costs being charged to federal employees and annuitants,” the inspector general of OPM has reported.

The BENEFEDS portal, through which enrollments for FEDVIP—and the long-term care insurance and flexible spending account programs—are made has “inadequate controls in place to verify dependent eligibility” and further does not have sufficient controls against fraud and abuse, said the report.

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It said that controls are adequate to determine whether an employee or retiree seeking to enroll is eligible, as well as to determine whether a dependent has aged out of eligibility by passing age 22. However, the audit said that lack of controls for determining whether family members are eligible for coverage in the first place allowed for situations including a grandfather claiming two grandchildren as his own children, several enrollees with two different people covered as a spouse at the same time, and some enrollees claiming more dependents under FEDVIP than under FEHB (in which eligibility continues up to age 26).

BENEFEDS does not have controls to “deter an enrollee from adding ineligible dependents,” the report said. Instead, “enrollees simply self-certify family members with no requirement for the FEDVIP carriers or BENEFEDS to verify dependent eligibility. This lack of responsibility by all parties involved increases the risk of fraud and abuse by not preventing ineligible dependents from enrolling in a federal program that is funded entirely by federal employees and annuitants.”

It recommended creating a system to collect documentation to verify eligibility at the time of enrollment.