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Audit of Claims Processing and Payment Operations at Blue Cross and Blue Shield of North Carolina for Contract Years 2018 through 2020

Submitting OIG: 
Office of Personnel Management OIG
Date Issued: 
Friday, March 3, 2023
Agency Reviewed / Investigated: 
Office of Personnel Management
Submitting OIG-Specific Report Number: 
2022-CAAG-0023
Component, if applicable: 
Federal Employees Health Benefits Program
External entity, if applicable: 
Blue Cross and Blue Shield of North Carolina
Location(s): 
Agency-Wide
Type of Report: 
Audit
Questioned Costs: 
$0
Funds for Better Use: 
$0
Number of Recommendations: 
4
View Document: 
AttachmentSize
PDF icon 2022-CAAG-0023.pdf765.11 KB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
1 Open No
We recommend that the contracting officer disallow $1,876,349 in overcharges to the FEHBP due to procedure code modifier claim payment errors.
2 Open No
We recommend that the contracting officer direct the Association to initiate recovery on and return all funds recovered for those FEHBP claims affected by this system error incurred in 2017 and 2021 that are not included in the totals of this finding.
Displaying 2 of 2 Recommendations