Federal Feedback by Kevin Wilkinson

Date published: 7/29/2007

ONCE AGAIN, I am applauding the efforts of the Office of Inspector General at the Office of Personnel Management for its oversight and audit efforts.

With more than $35 billion expended yearly on programs that benefit federal workers, retirees and survivors, OPM's inspector general reported the recovery of more than $171 million in funds related to the Federal Employees Health Benefits Program and Federal Employees' Group Life Insurance.

What is truly amazing is that these huge recoveries took place in just a six-month period, from October 2006 through March 2007.

These enforcement actions not only resulted in the recovery of monies that were improperly distributed, but led to the arrest and conviction of more than 20 individuals.

As you can imagine, health care fraud is a big concern for OPM's IG. The FEHBP covers an estimated 8 million people, and at the end of March OPM reported more than 282 active investigations. In the six months just reported, OPM opened 61 cases and closed 68.

OPM uncovered one physician in Texas who defrauded the FEHBP of more than $2.3 million. For these crimes, the physician was ordered to pay $10 million in fines and restitution and is currently awaiting prison sentencing.

Not all of the enforcement actions or audit findings uncovered illegal activity, but many of the payments were deemed improper or inappropriate. For example, the IG found instances where health insurance providers were still paying benefits to dependents of federal workers over the age of 22. They issued 14 audit reports that required these providers to return almost $18 million to the FEHBP.

It was interesting to note that "Employee Organization Plans" operating under the FEHBP, which are geared toward employee unions, associations or specific professions, had only one audit that identified just $2.6 million in questionable benefit payments. This was a plan marketed to a federal hospital association in Missouri.

Date published: 7/29/2007