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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
2023-CAAG-020
Report Type
Audit
Agency Wide
Yes
Number of Recommendations
3
Questioned Costs
$0
Funds for Better Use
$0
External Entity
Regence

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
1 No $0 $0

We recommend that the Contracting Officer require the Association to update its APM to direct local plans to ensure that all debarred and suspended providers in its local area are added to their local provider databases and flagged as debarred or suspended, even if the providers have not previously submitted FEHBP claims (including adding Non-Par providers on the OPM OIG listing, if necessary) so claims paid to them will be flagged if presented to the local Plans as required by the Guidelines.

2 No $0 $0

We recommend that the Contracting Officer require the Association to update its APM to include other (non-SSN) matching criteria available on the OPM OIG debarred or suspended provider listing for potential partial matches for flagging purposes in its DPF and local plan provider databases. The Association should also provide training to its local plans to ensure that they understand the importance of these additional matching criteria.

3 No $0 $0

We recommend that the Contracting Officer require the Association to update its claims processing system with edits to ensure that claim lines with telehealth-related POS and modifier codes suspend for review prior to payment.

Office of Personnel Management OIG

United States