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Federal office ferrets out fraud Date published: 2/27/2005
This amount includes $58 billion to 2.5 million retired workers and survivors; $33 billion for health insurance benefits for 8 million enrollees and $3 billion in life-insurance claims. OPM's Office of Inspector General is charged with auditing these programs and checking for waste, fraud and abuse. I recently reviewed the office's most recent semi-annual report to Congress and was impressed with its ability to uncover misconduct and other wrongdoing by employees, health-care providers and benefit recipients. In the area of health-care fraud, these investigations led to three arrests, 13 indictments and 11 convictions, with monetary recoveries totaling almost $5 million. In addition, the Inspector General's audit activities issued almost 2,000 debarments and suspensions for health-care providers operating under the Federal Employees Health Benefits Program. A debarment can stop someone from dealing with the program for up to 10 years. In one Virginia case, a physician pleaded guilty to fraud, received 18 months incarceration and was ordered to pay $200,000 in restitution for a three-year scheme involving the fraudulent submission of claims. Health-care providers weren't the only focus of the audit activities. Some 23 carriers of health-insurance plans that are offered under the health-benefits program were ordered to pay back more than $47 million for overcharging. In a Pennsylvania case involving a local HMO, auditors questioned more than $2 million in overcharges alone and the plan agreed to return almost $1.1 million in settlement. Small health-insurance providers are not the only violators. Blue Cross Blue Shield of Washington and Chicago agreed to credit the health-benefits program with more than $10 million for drug rebates and refunds they received from pharmacy vendors and drug manufacturers. Health-care providers and insurance companies aren't the only ones involved in questionable activities. For example, an employee of the Agriculture Department defrauded the health-benefits program by submitting bogus claims for medical treatment. He was ordered to pay almost $70,000 in fines and restitution, and received jail and supervised release time. In areas involving retirement fraud, OPM uncovered cases where survivor benefits were still being collected long after the beneficiary died. In separate cases involving the 1993 and 1994 deaths of retirement beneficiaries, the next of kin did not notify OPM of the deaths and pocketed more than $100,000 each. I am grateful for OPM's work to ensure the integrity of these programs that are so vital to federal workers, annuitants and their families. As a recipient of these benefits, you can help OPM's Inspector General by reporting incidents of fraud, waste and abuse by calling their hot line at 202/606-2433. OPM assures callers that they can remain anonymous and that the information is confidential. KEVIN WILKINSON of Spotsylvania County is a veteran federal employee. Write him c/o Federal Feedback, The Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401. Or e-mail kwlknsn@yahoo.com.
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