Stop Health Care Fraud!

Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits Program premium.

OPM's Office of the Inspector General investigates all 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 that you can do to prevent fraud:

  • Do not give your plan identification (ID) number over the telephone or to people you do not know, except for your health care provider, authorized health benefits plan, or OPM representative.


  • Let only the appropriate medical professionals review your medical record or recommend services.


  • Avoid using health care providers who say that an item or service is not usually covered, but they know how to bill us to get it paid.


  • Carefully review explanations of benefits (EOBs) statements that you receive from us.


  • Do not ask your doctor to make false entries on certificates, bills or records in order to get us 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 us at 1-800/638-6589 or 301/984-1440 (for TDD, use 301/984-4155) and explain the situation.

    If we do not resolve the issue:
    CALL -- THE HEALTH CARE FRAUD HOTLINE
    202-418-3300

    OR WRITE TO:

    United States Office of Personnel Management
    Office of the Inspector General Fraud Hotline
    1900 E Street NW Room 6400
    Washington, DC 20415-1100

  • Do not maintain as a family member on your policy:

    Your former spouse after a divorce decree or annulment is final (even if a court order stipulates otherwise); or

    Your child over age 22 (unless he/she is disabled and incapable of self support).


  • If you have any questions about the eligibility of a dependent, check with your personnel office if you are employed, with your retirement office (such as OPM) if you are retired, or with the National Finance Center if you are enrolled under Temporary Continuation of Coverage.


  • 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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