OPM Should Promote Medical Necessity Programs for Federal Employees' Health Insurance

摘要

This is GAO's third report calling for the Office of Personnel Management to pay more attention to the medical necessity provisions of its Federal Employees Health Benefits program contracts. OPM has been slow to encourage health insurance plans to use medical necessity programs which are designed to help hold down medical costs and to encourage good medical practice. Promoted by many health insurers and approved by numerous medical specialty societies, the programs have been available since 1977. Until recently, however, OPM provided virtually no guidance to participating health insurance plans about medical necessity programs. Plans' awareness and use of them varied greatly. OPM should monitor the programs, evaluate their benefits, and require health insurance plans to use their beneficial aspects.