Officials of several employing offices and insurance carriers told GAO that they take only limited steps to identify and remove ineligible persons. Image: ADragan/Shutterstock.com
By: FEDweek StaffA newly offered bipartisan bill (S-4035) in the Senate seeks to compel more action to cull ineligible persons from FEHB coverage, an issue that has been raised repeatedly in recent years in reports from the GAO and from the inspector general’s office at OPM.
The bill would put the force of law behind recommendations in those reports to require OPM to verify eligibility before adding family members; include ineligible members as a fraud risk when OPM does their annual fraud risk assessment;
It further requires a “complete a comprehensive audit” of FEHB for ineligible family members and gives OPM “explicit authority” to remove individuals found to be ineligible, sponsors said in a summary.
A GAO report issued last year said that despite several sets of guidance OPM has issued to agencies and carriers, OPM still “cannot reasonably ensure ineligible family members are not covered in FEHB enrollments” and lacks a monitoring mechanism to identify and remove ineligible persons. 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.
The GAO estimated that ineligible persons being carried as family members incur some $1 billion in claims each year, costs that are passed on to enrollees and the government in the form of higher premiums.
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