The U.S. Office of Personnel Management issued a letter June 10 to Federal Employees Health Benefits and Postal Service Health Benefits carriers on fraud, waste and abuse compliance requirements.
The letter reiterates expectations of carriers, the office said. Robust FWA efforts include identification, prevention, remediation and reporting across all aspects of the business, including claims administration, pharmacy benefit management, subcontractors, enrollment and providers.
In the letter, OPM said it is “immediately” broadening oversight of carriers’ FWA programs, as well. It will conduct oversight reviews, inspections, audits, operational assessments and carrier site visits.
OPM is also forming a data science and audit team for proactive fraud detection, eventually ending retroactive reviews. The team would check de-identified claims data in collaboration with the OPM Office of Inspector General.
The efforts come as OPM works with Vice President JD Vance’s White House Task Force to Eliminate Fraud.
“Working alongside the White House Task Force to Eliminate Fraud, OPM is taking additional steps to safeguard the premiums paid by federal employees and taxpayers, protect beneficiaries, and ensure health insurance companies are meeting the highest standards of accountability,” OPM Director Scott Kupor said in a news release.
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