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Where To Report Waste
Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation
Recommendation Details
Text of Recommendation
We recommend that the contracting officer direct the Plan to perform a review of its paid claims on a routine basis (i.e., monthly, quarterly, and/or annually) to verify the accuracy of its COB processing. The Plan’s methodology for selecting claims to review should include consideration of those claims most likely to require COB (e.g., basic Class A services that include oral examinations, prophylaxis, diagnostic evaluations, sealants and x-rays.). The results of these reviews should be shared with OPM to identify error rates, causes of errors, performance improvements, and agreed-upon solutions to resolve problems.
Recommendation Number
3
Recommendation Status
Closed
Significant Recommendation
Yes
Recommendation Questioned Costs
$0
Recommendation Funds for Better Use
$0