Comer Wants to Know Why Fed Worker Health Program Pays $1 Billion for Ineligible Members

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House Committee on Oversight and Accountability Chairman James Comer (R-Ky.) is demanding to know why the Federal Employee Health Benefits Program (FEHBP) is shelling out more than $1 billion annually in payments for people who arenโ€™t eligible participants.

Comer told Office of Personnel Management (OPM) Director Kiran Ahuja in a Jan. 23 letter that a recent report compiled by the Government Accounting Office (GAO) found โ€œthat FEHB is riddled with ineligible โ€˜participantsโ€™ who are receiving benefits under the program. GAO estimates that โ€˜the program may be spending up to $1 billion per year on payments for ineligible members.โ€™

โ€œThis is a flagrant waste of funds and may be driving up premium costs for eligible participants.โ€

The FEHBP, which is managed by OPM, is the health insurance program offered solely to the 2.2 million federal civil service employees, their families, and retirees. More than 8 million people currently are counted as participants in FEHBP.

The FEHBP, the largest health benefits program in the country, cost the federal government more than $59 billion in 2021. The OPM manages the federal governmentโ€™s 2.2 million active career civil servants, as well as the Federal Employee Retirement System and the Civil Service Retirement System programs, which together represent the federal governmentโ€™s third-largest entitlement program. There are about 2.7 million federal employee retirees.

In 2016, hackers linked to the Chinese Communist Party broke into OPMโ€™s computer system and stole personal and financial information for nearly 5 million federal workers and retirees.

Comer told Ahuja that the GAO report โ€œsuggests OPM has been aware of this problem for years but has consistently failed to address it effectively. As GAO recounts, OPM acknowledged the possibility of a problem when it issued regulations in 2018 allowing agencies and participating insurers to request proof of eligibility for federal employeesโ€™ family members. OPM did not, however, actually require proof of eligibility.โ€

Byย Mark Tapscott

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