An inspector general audit has found weaknesses in the FEHB health insurance and FEDVIP dental-vision insurance programs, including repeating a prior warning about ineligible persons being enrolled in both and driving up premium costs.
OPM recently sent guidance on the enrollment issue, telling both agencies and insurance carriers that they can demand proof of eligibility and outlining steps to take to remove ineligible persons. However, it stopped short of ordering either agencies or carriers to conduct a full audit.
The IG report also said that OPM (in its words):
* does not have sufficient controls in place to track FEHBP carrier working capital;
* lacks transparency standards for both pharmacy and medical claims in its community-rated health maintenance organization contracts;
* is not conducting FEHBP health carrier site visits on a three-year rotational basis in accordance with its documented internal control to mitigate risks associated with the FEHBP payment process;
* lacks internal policies to ensure timely and accurate submission of fraud, waste, and abuse reports for the FEHBP and FEDVIP;
* lacks a formal fraud, waste, and abuse and debarment/suspension requirement for FEDVIP carriers;
* does not have sufficient controls in place to collect and review FEDVIP annual accounting statements; and
* needs to improve the FEDVIP by establishing standardized performance measures with penalties.
OPM management agreed with some of the recommendations but not others. For example, it said it is developing a master index of all FEHB enrollees and covered family members but said “we do not currently believe it feasible” to have agencies and carriers verify a new enrollment’s family members during the annual open season as the IG recommended.
Many of the other recommendations dealt with technical aspects of the programs.