Pennsylvania Attorney General Dave Sunday explains a $12 million Medicaid bust of a Philadelphia pharmacy. allegedly fraudulently collected millions in Medicaid reimbursements for prescriptions it never fulfilled.
FIRST ON FOX:The Trump administration is lifting the hood on federal health benefits programs that cover millions of Americans, ordering insurance carriers to tighten fraud controls as part of a broader crackdown on waste. abuse, Fox News Digital learned.
"Working alongside theWhite HouseTask Force to Eliminate Fraud, OPM is taking additional steps to safeguard the premiums paid by federal employees. taxpayers, protect beneficiaries, and ensure health insurance companies are meeting the highest standards of accountability," said Office of Personnel Management (OPM) director Scott Kupor to Fox News Digital.
OPM functions as the federal government’s human resources agency, overseeing civilian personnel policy. administering benefits for federal employees, retirees and their families.
OPM, partnered with the White House Task Force to Eliminate Fraud, is sending new compliance expectations on Wednesday to insurance carriers in the Federal Employees Health Benefits. Postal Service Health Benefits programs, directing them to strengthen fraud prevention, payment reviews, pharmacy benefit oversight, subcontractor accountability, audits and reporting, Fox News Digital learned.
READ: DR. OZ PUTS ALL 50 GOVERNORS ON NOTICE OVER BILLIONS LOST TO MEDICAID FRAUD
FEHB cost taxpayers about $70 billion. covered more than 8.2 million federal employees, family members, and other eligible individuals in 2024.(Jeffrey Greenberg/Universal Images Group via Getty Images)
The push also targets pharmacy benefit managers, the drug-pricing middlemen that administer prescription drug benefits for health plans. negotiate with drugmakers and pharmacies.
The FEHB program cost the government. enrollees about $70 billion in fiscal 2024 and covered more than 8.2 million federal employees, family members and other eligible individuals, according to the U.S.Government AccountabilityOffice.
"OPM is a valuable partner and leader on the Task Force. The steps taken today will protect taxpayers. our federal workforce," White House Task Force Executive Director Scott Brady told Fox News Digital.
OPM is also building a data science. audit team with the agency’s inspector general to review anonymized claims data and detect fraud, waste and overbilling more proactively.
HOUSE GOP LAUNCHES NEW TASK FORCE, PROBES ALLEGED $250B MEDICAID FRAUD IN OHIO
The White House Task Force has amped up its fraud investigations. narrowing in on medical corruption.(Oliver Contreras / AFP via Getty Images)
The Government Accountability Officesaid in a July 2025report that OPM should do more to manage fraud risks in the FEHB program, citing risks including benefit card sharing, improper inducements, insufficient or fraudulent documentation, kickbacks, marketing fraud, theft of personally identifiable information, provider ineligibility. self-referrals.
The announcement marks the latestcrackdown in medical programsfollowing the launch of a nationwide probe into Medicaid.
OPM has given orders to insurance companies handling federal employee health benefits to launch investigations into payments, pharmacy benefit oversights,. subcontractors.(Eric Thayer/Bloomberg via Getty Images)
CMS directed all 50 statesto submit plans to revalidate high-risk Medicaid providers. including providers subject to less rigorous enrollment standards or operating without a National Provider Identifier in April.
Vice President JD Vance. who is leading the task force, amplified the call in May, saying during a news conference that states could lose federal funding if they fail to aggressively pursue Medicaid fraud.
The push comes amid heightened focus on large-scale fraud cases. including Minnesota’s $250 million "Feeding Our Future" scheme, which became a national flashpoint in recent months.
Ashley J. DiMella reports on politics for Fox News Digital.
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