Peter Hayes’ Post

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CEO and President of Healthcare Solutions

So basically, the Office of Chief Financial Officer has no written policies or procedures governing the management or accounting for the FEHBP Trust Fund, no means by which to manage and adequately oversee carrier funding requests, and NO FRAUD POLICY or ANTIFRAUD STRATEGY. The quote above is deeply troubling. It is so easy to spend other's money. Chris DeaconStacy MaysStacey RichterGe BaiShawn GremmingerLarry BeckerRob Marty, DBA, MHAScott Conard, MD

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Speaker. Thought Leader. Truth Teller. Disruptor. *All content non-AI Generated*

When I read this latest audit, I must say that even I was a bit shocked (and trust me, that takes a lot in this business). The Office of the Inspector General (OIG) of Office of Personnel Management's (OPM) latest audit report about the Federal Employees Health Benefits Program (FEHBP) is downright disturbing in what it says about the oversight of our tax dollars, or should I say lack thereof. OIG audit focused on OPM's Subscription Income Process, which is basically the management and accounting of over $55 billion in health benefits premiums received from agency payroll providers and paid to Federal Employees Health Benefits Program (FEHBP) health insurance carriers (like BCBS, Anthem, etc.). The main objective was to gather detailed information about these processes and identify internal control weaknesses. The audit research found that while internal controls were "explained" by personnel in interviews and verbal understandings, most were not documented in written policies and procedures, thereby preventing a full audit from being conducted. Here are some of the more disturbing quotes from the audit: ▶ "Other than the OPM Carrier Handbook, which provides guidance to FEHBP carriers, there are no Office of Chief Financial Officer (OCFO) written policies and procedures over the process for approving and paying funds to the carriers via the Automated Clearing House (ACH) payment system" ▶ "..outside of financial system user manuals, there are only four other policy and procedure documents with a nexus to the Subscription Income Process" ▶ "The Trust Funds Management office [which is responsible for overseeing the trust fund which collects and disburses health insurance premiums to carriers who participate in the FEHBP, and manages the contingency reserves] lacks written policies and procedures for approving and transferring funds from the contingency reserve to the carriers via the Letter of Credit system and via ACH." ▶ "[OCFO has no written policies or procedures over] Approval and payment of funds to the carriers via ACH • Approval and transfer of funds from the contingency reserve to the Letter of Credit system • Approval and transfer of funds from the contingency reserve to the FEHBP carriers via ACH." And my personal favorite.... ▶ "During the course of our audit research, we identified an additional area of concern outside the scope of the announced audit research ... We identified that OPM lacks an enterprise-wide fraud policy or an antifraud strategy." So basically, the Office of Chief Financial Officer has no written policies or procedures governing the management or accounting for the FEHBP Trust Fund, no means by which to manage and adequately oversee carrier funding requests, and NO FRAUD POLICY or ANTIFRAUD STRATEGY. Seriously, are there any adults in the room? William SarrailleAndy MychkovskyLee LewisMarilyn Bartlett Jeffrey HoganAl Lewis 🇺🇦 Peter Hayes Shawn Gremminger

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Peter Hayes

CEO and President of Healthcare Solutions

2w

Here is a quote to consider for the post above.

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