U.S. Office of Personnel Management www.opm.gov - Recruiting, Retaining and Honoring a World-Class Workforce to Serve the American People

INVESTIGATIONS

In the Office of Investigations, we help preserve the integrity of OPM programs by investigating allegations of fraud, waste, or abuse.  Both American taxpayers and Federal employees are harmed when thieves steal from OPM programs or when misconduct compromises program integrity.  Whenever feasible, we coordinate our investigations with the Department of Justice (DOJ) and other Federal, state, and local law enforcement agencies.  When the evidence shows a violation has occurred, we pursue criminal prosecution, civil action, and/or administrative penalties against the offenders. 

INSURANCE FRAUD

We investigate alleged fraud affecting the insurance programs administered by OPM, including the Federal Employees Health Benefits Program (FEHBP), the Federal Employees Group Life Insurance Program (FEGLI), the Federal Employees Dental/Vision Program (FEDVIP), the Federal Long Term Care Insurance Program (FLTCIP), and the Federal Flexible Spending Account Program (FSAFEDS).  The OIG maintains an Insurance Fraud Hotline which allows concerned parties to report allegations of fraud, waste, or abuse directly to the OIG.  We also work with insurance carriers to identify those who submit false claims or cause false claims to be submitted, and with OIG auditors to identify possible fraud by insurance carriers.  When appropriate, we refer health care providers to the OIG’s Debarring Official for possible suspension or debarment from the FEHBP.

The investigation of health care fraud in the FEHBP is a priority for us, particularly cases involving a risk of physical harm to the patient or significant financial loss to the FEHB Trust Fund.  We investigate health care fraud committed by federal employees, retirees, and their family members; by medical professionals; by medical facilities; by retailers, distributors, or manufacturers of medical equipment, supplies, and pharmaceuticals; by insurance companies and benefits managers; and by criminal organizations.  Examples of the types of cases we investigate include billing for services not rendered, billing under stolen identities, billing for unnecessary services, billing under false diagnoses, misrepresenting services to make them reimbursable or to make them seem more complicated and expensive than they actually were, billing for services rendered by unqualified or unlicensed personnel, and using insurance benefits to pay for the diversion of prescription drugs for illegal sale or abusive personal use.  Health care fraud cases are often time-consuming and complex, and may involve multiple subjects and multiple health insurance plans.  Our investigations are critical to protecting Federal employees, annuitants, and members of their families who are eligible to participate in the FEHBP. 

RETIREMENT FRAUD

We investigate fraud involving the Civil Service Retirement System (CSRS) and the Federal Employees Retirement System (FERS).  We maintain a Retirement and Special Investigations Hotline which allows concerned parties to report allegations of fraud, waste, and abuse directly to the OIG.  OPM’s Center for Retirement and Insurance Services routinely refers to our office potential retirement fraud cases identified through computer death matches with the Social Security Administration (SSA) and other internal controls.  Retirement fraud referrals come to our office from other Federal, state, and local agencies, as well.  The OIG also uses a variety of proactive initiatives and data analysis techniques to identify potential retirement fraud. 

The most common type of retirement fraud involves the receipt and use of CSRS or FERS annuity benefit payments by someone who is not entitled to receive the annuity.  This most often occurs when someone (frequently an adult child of the beneficiary) fails to report and/or intentionally conceals the death of an annuitant or survivor annuitant in order to take the annuity payments.  However, we also investigate the theft or diversion of payments issued to living beneficiaries, as well as embezzlement from the retirement trust funds. 

SPECIAL INVESTIGATIONS

We also investigate misconduct by OPM employees or contractors; fraud in OPM contracts; fraud in OPM’s revolving fund activities; and fraud, waste, or abuse in the variety of other programs administered by OPM.  Examples of OPM programs include, but are not limited to, the personnel security and suitability program managed by OPM’s Federal Investigative Services (FIS), the Combined Federal Campaign, the Federal Executive Institute and Management Development Centers, USAJOBS, and Nationwide Testing.  Anyone who wishes to report allegations of fraud, waste, or abuse committed by OPM employees, OPM contractors, or affecting any OPM program, may contact our Retirement and Special Investigations Hotline.

One of our priorities in the Special Investigations arena involves allegations of fraud in the personnel security and suitability program.  OPM conducts approximately 90 percent of all personnel background investigations for the Federal Government.  Agencies use the background and suitability investigations conducted by OPM or OPM contractors to determine individuals?suitability for employment and eligibility for access to national security classified information.  We investigate alleged fabrication by background investigators (i.e., the submission of work products that purport to represent investigative work which was not in fact performed).   We consider such cases to be a serious national security concern.  If a background investigation contains incorrect, incomplete, or fraudulent information, a qualified candidate may be wrongfully denied employment or an unsuitable person may be cleared and allowed access to Federal facilities or classified information.  When our criminal investigations reveal evidence that a background investigator falsified his or her work product, we coordinate with DOJ to criminally prosecute the background investigator.

ALERT ?DON’T BE A VICTIM OF MEDICAL IDENTITY THEFT - PROTECT YOUR INSURANCE POLICY NUMBER AS YOU WOULD YOUR CREDIT CARD INFORMATION AND REVIEW YOUR MEDICAL BILLS AND EXPLANATION OF BENEFITS STATEMENTS.