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Report File
Date Issued
Submitting OIG
Office of Personnel Management OIG
Other Participating OIGs
Office of Personnel Management OIG
Agencies Reviewed/Investigated
Office of Personnel Management
Components
Federal Employees Health Benefits Program
Report Number
2022-SAG-029
Report Type
Audit
Agency Wide
Yes
Number of Recommendations
15
Questioned Costs
$44,882,688
Funds for Better Use
$0
External Entity
Express Scripts, Inc.

Open Recommendations

This report has 7 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
3 No $0 $12,484,472

We recommend that OPM's Contracting Officer require the PBM and Carrier to return $12,484,472 to the FEHBP for its portion of retail pharmacy pricing discounts not received from the PBM for CYs 2016 through 2021.

8 No $0 $1,397,520

We recommend that OPM's Contracting Officer require the PBM and Carrier to return the FEHBP's portion of the PBM's "non-specific drug discounts" going back to the start of the Carrier's transparent agreement with the PBM, specifically for the period of CYs 2012 through 2015. The PBM has already identified an additional $1,397,520 in drug inventory purchasing discounts for CY 2015 that should be returned to the FEHBP as overcharges.

4 No $0 $1,884,412

We recommend that OPM's Contracting Officer assess the PBM and Carrier $1,884,412 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2023. The LII should be adjusted to account for the date the questioned costs are returned to the program.

6 No $0 $5,911,973

We recommend that OPM's Contracting Officer require the PBM and Carrier to return $5,911,973 to the FEHBP for its portion of the PBM's non-specific drug inventory purchasing discounts that were not received for CYs 2016 through 2021.

7 No $0 $911,290

We recommend that OPM's Contracting Officer assess the PBM and Carrier $911,290 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2023. The LII should be adjusted to account for the date the questioned costs are returned to the program.

10 No $0 $2,279,264

We recommend that Carrier collect $2,279,264 in claim transaction fees that were credited back to the PBM by retail pharmacies for the Carrier's CY 2016 through 2021 prescription drug benefits.

11 No $0 $289,501

We recommend that OPM's Contracting Officer assess the PBM and Carrier $289,501 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2023. The LII should be adjusted to account for the date the questioned costs are returned to the program.

Office of Personnel Management OIG

United States