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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
1H-08-00-21-015
Report Type
Audit
Agency Wide
Yes
Number of Recommendations
12
Questioned Costs
$15,086,271
Funds for Better Use
$0
External Entity
Group Health Incorporated

Open Recommendations

This report has 10 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
1 No $11,251,490 $0

We recommend that OPM's Contracting Officer require the Carrier to return $11,251,490 to the FEHBP for pass-through transparent drug pricing that was not received from the PBM for CYs 2015 through 2019.

2 No $1,228,855 $0

We recommend that OPM's Contracting Officer assess the Carrier $1,228,855 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2022. The LII should be adjusted to account for the date the questioned costs are returned to the program.

3 No $816,814 $0

We recommend that OPM's Contracting Officer require the Carrier to return $816,814 to the FEHBP for its portion of the PBM's non-specific drug discounts that were not received due to the Carrier's failure to move its FEHBP experience-rated group to a transparent PBM arrangement with pass-through pricing for CYs 2015 through 2019.

4 No $100,559 $0

We recommend that OPM's Contracting Officer assess the Carrier $100,559 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2022. The LII should be adjusted to account for the date the questioned costs are returned to the program.

5 No $531,868 $0
6 No $56,697 $0

We recommend that OPM's Contracting Officer assess the Carrier $56,697 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2022. The LII should be adjusted to account for the date the questioned costs are returned to the program.

7 No $957,512 $0

We recommend that OPM's Contracting Officer require the Carrier to return $957,512 to the FEHBP for the underpayment of drug manufacturer rebates and corresponding administrative fees that were withheld by the PBM for CYs 2015 through 2019.

8 No $90,895 $0

We recommend that OPM's Contracting Officer assess the Carrier $90,895 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2022. The LII should be adjusted to account for the date the questioned costs are returned to the program.

9 No $45,986 $0

We recommend that the Carrier return $45,986 to the FEHBP for the Federal group's portion of the penalties that were paid by the PBM to the Carrier for missed performance guarantees from CYs 2015 through 2019.

10 No $5,595 $0

We recommend that OPM's Contracting Officer assess the Carrier $5,595 for LII on the questioned costs due back to the FEHBP for this finding, calculated through December 31, 2022. 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