A report estimated the cost to be between $360 million and $1 billion a year. Image: Teacher Photo/Shutterstock.com
By: FEDweek StaffThe GAO has cited the cost in added premiums for both the government and enrollees in the FEHB program in recommending stepped-up efforts to prevent ineligible persons from being covered and to find and remove such persons already being covered.
A report estimated the cost to be between $360 million and $1 billion a year; since enrollees on average pay 30 percent of the total premium cost and the government the rest, that would translate into between $108 million and $300 million in additional premium costs to enrollees.
“Removing ineligible family members from the program is essential for preventing and detecting fraud and improper payments in the program. Until OPM implements a monitoring mechanism, more ineligible participants and related improper payments in the program may continue to accrue,” it said.
GAO raised the issue in a recent report on overlap, duplication and fragmentation in government programs that also has a section on potential cost savings. That follows a report earlier this year from GAO and several in recent years from the inspector general’s office at OPM raising those same concerns.
The issue also arose at a recent House hearing on OPM, suggesting that Congress may order some type of action legislatively.
In the new report, the GAO noted that under rules OPM issued in 2018, “employing offices and carriers may—but are not required to—request proof of family member eligibility at any time for existing participants. OPM also issued new requirements in 2021 for employing offices and carriers to verify family member eligibility for certain types of new enrollments.”
However, it said that OPM “still lacks a plan to establish a monitoring mechanism to identify and remove ineligible family members who already have” coverage. While OPM concurred with a recommendation to create such a system, “it is too soon to determine whether the steps OPM plans to take” will be effective in culling them out.
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