A government watchdog agency on Monday reported that although the Office of Personnel Management has recently implemented a new system to reduce the risk of fraud within the Federal Employees Health Benefits Program, additional steps are needed to monitor participants’ eligibility.
The Government Accountability Office said that from FEHBP’s inception until 2018, OPM has delegated responsibility for determining whether relatives of federal employees were eligible for coverage under the federal government’s health insurance program, which currently covers around 8 million people across 276 different insurance plans. Regulations issued in 2018 allow federal agencies or OPM to request proof of family members’ eligibility for the program, such as a birth certificate.
And in 2021, OPM issued guidance to agencies and insurance carriers requiring them to verify the eligibility of family members of federal workers when they are hired and upon enrollment changes made due to significant life events, like getting married or the birth of a child. But GAO reported that the requirement does not extend to when feds change their enrollment as part of the annual open season period.
