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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-CAAG-0014
Report Type
Audit
Agency Wide
Yes
Number of Recommendations
5
Questioned Costs
$0
Funds for Better Use
$0

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
5 No $0 $0

We recommend that OPM direct its carriers to issue guidance to members and providers on telehealth billing, privacy and security, and quality of care risks.

2 No $0 $0

We recommend that OPM develop and maintain a list of services that can be provided via telehealth and require carriers to place edits in their claims systems that will check telehealth claims against this list. Any telehealth claims with procedure codes indicating services not on this list should pend for medical review prior to payment. OPM could start with the list maintained by CMS, expanding the allowed services if desired.

3 No $0 $0

We recommend that OPM specify the telehealth technology laws and regulations with which FEHBP providers must comply or create its own list of requirements, if preferred, and require FEHBP carriers to ensure providers are implementing these requirements.

4 No $0 $0

We recommend that OPM consult with the Office of the General Counsel (OGC) to determine the legal sufficiency of OPM's preemptive authority to implement a uniform framework requiring FEHBP providers to obtain informed consent from all parties before recording audio or video telehealth sessions. Should OGC conclude that OPM's preemptive authority is not sufficient to require FEHBP providers to obtain informed consent in all circumstances, then we recommend that OPM issue guidance to FEHBP carriers recommending that FEHBP providers obtain informed consent, where required by existing and applicable authorities. Regardless of OGC's determination, we also recommend that the guidance OPM sends to the FEHBP carriers should require them to educate members about the importance of informed consent regarding telehealth visits, both when a provider wishes to record and if a member wishes to record their own session.

1 No $0 $0

We recommend that OPM direct carriers to review their claims system edits as they relate to telehealth claims and to implement appropriate claim audits and/or data analytics to identify potentially fraudulent, wasteful, or abusive telehealth billing practices.

Office of Personnel Management OIG

United States