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 aren’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 “that FEHB is riddled with ineligible ‘participants’ who are receiving benefits under the program. GAO estimates that ‘the program may be spending up to $1 billion per year on payments for ineligible members.’

“This is a flagrant waste of funds and may be driving up premium costs for eligible participants.”

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 government’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 government’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 OPM’s computer system and stole personal and financial information for nearly 5 million federal workers and retirees.

Comer told Ahuja that the GAO report “suggests 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 employees’ family members. OPM did not, however, actually require proof of eligibility.”

By Mark Tapscott

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