In audit findings published Jan. 8, the Office Of Personnel Management’s OIG said the insurer failed to recover or return $6.79 million from 135 claim overpayments, including payments to providers and members. The auditors said that Florida Blue did not take sufficient steps to return these funds, such as utilizing provider offsets, certified letters, or third-party collections.
Beyond claim overpayments, the audit flagged $804,721 in uncollected subrogation recoveries, $249,632 in unrecovered medical drug rebates, and $29,443 in unreturned special plan invoices. Another $20,586 in provider offset refunds was also outstanding as of mid-2023.
Administrative charges also came under scrutiny, with $151,665 identified as overcharges. This included $138,843 in out-of-system adjustments and $12,822 in lost investment income tied to those adjustments.
The audit found that Florida Blue held an excess working capital deposit of $125,946 and $8,128 in excess funds in its dedicated FEHBP investment account. The insurer also failed to promptly return $16,590 in interest income earned on FEHBP funds.
In its response, Florida Blue contested over $7 million of the findings but acknowledged $1.41 million in questioned charges, which it has since returned. The audit recommended that Florida Blue take corrective actions to improve its recovery efforts, financial oversight, and compliance with federal regulations.
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