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U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

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Insurance Services Programs

Federal Employee Health Benefit Program

RI 70-5 For TCC and Former Spouse Enrollees

Stop Health Care Fraud

Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits (FEHB) Program premium. OPM's Office of the Inspector General investigates allegations of fraud, waste, and abuse in the FEHB Program, regardless of the agency that employs you or from which you retired.

Protect Yourself From Fraud - Here are some things you can do to prevent fraud:

  • Be wary of giving your health plan identification number over the telephone or to people you do not know, except to your doctor, other provider, or authorized plan or OPM representative.
  • Let only the appropriate medical professionals review your medical record or recommend services.
  • Avoid health care providers who say that an item or service is not usually covered, but they know how to bill your health plan to get it paid.
  • Carefully review explanations of benefits (EOBs) that you receive from your health plan.
  • Do not ask your doctor to make false entries on certificates, bills, or records to get your health plan to pay for an item or service.
  • If you suspect that a provider has charged you for services you did not receive, billed you twice for the same service, or misrepresented any information, do the following:
    • Call the provider and ask for an explanation. There may be an error.
    • If the provider does not resolve the matter, call your health plan and explain the situation.
    • If they do not resolve the issue:

      OR WRITE TO:

      The United States Office of Personnel Management
      Office of the Inspector General Fraud Hotline
      1900 E Street, NW, Room 6400
      Washington, DC 20415

  • Remember, FEHB-covered family members may not include:
    • your former spouse after a divorce decree or annulment is final (even if a court orders it); or
    • your child over age 22 unless he/she became incapable of self support before age 22.
  • If you have any questions about the eligibility of a dependent, check with your Human Resources office if you are employed or with OPM if you are retired.
  • You can be prosecuted for fraud and your agency may take action against you if you falsify a claim to obtain FEHB benefits or try to obtain services for someone who is not an eligible family member or who is no longer enrolled in the Plan.

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