Where To Report Waste

Fraud, Abuse, Or Retaliation

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

Submitting OIG:

Office of Personnel Management OIG

Date Issued:

Wednesday, February 8, 2023

Agency Reviewed / Investigated:

Office of Personnel Management

Submitting OIG-Specific Report Number:

2022-CAAG-009

Component, if applicable:

Federal Employees Health Benefits Program

External entity, if applicable:

Premera Blue Cross

Location(s):

Agency-Wide

Type of Report:

Audit

Questioned Costs:

$0

Funds for Better Use:

$0

Number of Recommendations:

3

View Document:

Attachment	Size
2022-CAAG-009.pdf	847.35 KB

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation	Additional Details
1	Open	No
We recommend that the contracting officer disallow $1,944,914 in overcharges to the FEHBP for 2,243 claims that were incorrectly paid due to a system error related to the bundling of ambulatory payment classification claims. The Plan did not attempt to identify FEHBP claim overpayments or make efforts to recover the overpayments.
5	Open	No
We recommend that the contracting officer direct the Association to ensure the Plan notifies the members of the amounts they overpaid and direct the providers to reimburse them.
6	Open	No
We recommend that the contracting officer direct the Association to implement FEP-wide policies for local plans to follow to ensure member cost-share overcharges are properly reimbursed to them.