OPM Flags About $500 Million In Federal Health Benefit Fraud

The Office of Personnel Management said Tuesday that health carriers prevented nearly $510 million in losses and recovered $21.9 million after payment in federal health benefit programs amid probes of suspected fraud and waste.^[1]

OPM Director Scott Kupor said the agency oversees about $80 billion a year in health coverage for roughly 8.9 million federal employees and retirees.^[1] Kupor said OPM is, for the first time, independently analyzing health claims data to identify suspicious provider behavior.^[1] He said the agency will remove providers or refer suspected crimes to inspectors general and the Justice Department.^[1]

OPM presented the carrier recoveries and prevented losses as evidence that combining insurer reviews with its new data analysis can cut improper payments and provider abuse.^[1] The agency framed the shift as a step to protect benefits and taxpayer dollars while giving no immediate list of providers targeted for removal.^[1]

The announcement comes amid a broader federal emphasis on fraud enforcement led by a White House anti-fraud task force that reports $260.7 billion in fraud uncovered since the current administration began and $72 billion stopped on an annualized basis.^[1]

1. Fox News