OPM Orders Tighter Fraud Controls for $70 Billion Health Plans, Builds Data Audit Team
Updated
Updated · Fox News · Jun 10
OPM Orders Tighter Fraud Controls for $70 Billion Health Plans, Builds Data Audit Team
1 articles · Updated · Fox News · Jun 10
Summary
OPM on Wednesday told carriers in the Federal Employees Health Benefits and Postal Service Health Benefits programs to tighten fraud prevention, payment reviews, pharmacy oversight, subcontractor accountability, audits and reporting.
A new data science and audit team, built with OPM’s inspector general, will analyze anonymized claims data to detect fraud, waste and overbilling more proactively across plans covering millions of federal workers and families.
The push reaches pharmacy benefit managers as well as insurers, expanding scrutiny of prescription-drug middlemen inside a federal health system that cost about $70 billion and covered more than 8.2 million people in fiscal 2024.
A July 2025 GAO report had urged OPM to do more on FEHB fraud risks, citing benefit card sharing, kickbacks, marketing fraud, stolen personal data, provider ineligibility and self-referrals.
The move fits a broader Trump administration anti-fraud campaign that already launched a nationwide Medicaid probe, ordered all 50 states to revalidate high-risk providers and warned states they could lose federal funding if they fall short.