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HRD-79-87 1 (1979-09-07)

handle is hein.gao/gaobaazrc0001 and id is 1 raw text is: 




  REPORT        BY                           '4e ''. sFdeth


  Comptroller General


  OF THE UNITED STATES





  Stronger Management Needed

  To Improve Employee Organization

  Health Plans' Payment Practices



/The Office of Personnel Management has not
done an effective job of guiding and over-
seeing the Employee Organization Plans par-
ticipating in the Federal Employees Health
Benefits program. The Office has allowed
the plans to make claim payments without
determining whether the claims represented
medically necessary services or developing
sound, comprehensive systems to determine
the reasonableness of charges as the con-
tracts require,

The plans have paid claims for services not
covered and have made payments without
determining if claims represented reasonable
charges for medically necessary services. Pay-
ments outside the scope of the contracts
unnecessarily inflate the premium cost to
plans' enrollees and to the Government.

The Office of Personnel Management should
require the plans to adhere fully to their
contracts and pay reasonable amounts for
covered services.




                       ______0__ 3=III 1111111

                                                              110357


                                                                      HRD-79-87
                                                               SEPTEMBER 7, 1979

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