Audit of the U.S. Office of Personnel Management's Administration of Federal Employee Insurance Programs

Date Issued

Friday, October 30, 2020

Submitting OIG

Office of Personnel Management OIG

Other Participating OIGs

Office of Personnel Management OIG

Agencies Reviewed/Investigated

Office of Personnel Management

Components

Retirement Services

Report Number

4A-HI-00-19-007

Report Type

Audit

Agency Wide

Yes

Number of Recommendations

Open Recommendations

This report has 4 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
9	No	$0	$0
We recommend that OPM work with the OCFO to establish internal procedures for properly reviewing and verifying the accuracy and completeness of the working capital schedules reported in the AAS by FFS and ER HMO carriers.
11	No	$0	$0
We recommend that OPM establish PBM transparency standards for all new, renewed, or amended contracts that are specific to community-rated HMOs.
12	No	$0	$0
We recommend that OPM implement the following rate instruction changes: Include transparency standards requiring the carriers to provide support for all claims, encounters, and capitated rates, including those from their provider-owned networks or related entities used in the MLR, rate proposal, and rate reconciliation calculations; and Improve MLR criteria to provide complete, clear, and concise instructions of the FEHBP MLR process, including specific instructions concerning provider-sponsored health plans and capitated arrangements in its cost reporting.
13	No	$0	$0
We recommend that OPM develop formal policies to ensure that site visits are conducted every three years for FEHBP carriers in accordance with its control to meet OMB Circular A-123 requirements. If the time and costs to perform the site visits outweigh the benefits, OPM should modify its controls and report new procedures to mitigate risks for the FEHBP payment process.