BENEFEDS FWA Report Template.xls
XLS spreadsheet 46 KB Posted
- Attached to
- BENEFEDS PreSolicitation Notice
- Solicitation number
- 24361821R0002
- Issued by
-
Office of Personnel Management
About this file
This document contains a fraud and abuse reporting template and related pre-solicitation notice for the BENEFEDS federal employee benefits program. The template collects statistics on fraud cases investigated, dollars identified and recovered from losses, and referrals to law enforcement for the current year. It also includes a checklist for fraud prevention best practices. The pre-solicitation notice indicates a competitive solicitation will be issued for BENEFEDS third party administration services currently performed under a contract expiring on December 31, 2022. Interested offerors must ensure active SAM registrations and maintain eligibility until August 31, 2022. The new contract would include a six-month start-up period prior to a January 1, 2023 performance start date.
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Other files
| File | Type | Posted |
|---|---|---|
| RTM final 7.13.2021.xls | XLS spreadsheet | |
| ATT 5_FORMS -09.30.21 DRAFT.pdf | ||
| BENEFEDS QASP 10.6.21 DRAFT.pdf | ||
| BENEFEDS PWS 10.06.21 DRAFT.pdf | ||
| BENEFEDS Appendices 10.06.21 DRAFT.pdf | ||
| Interested Parties List for PreSolicitation Notice BENEFEDS.docx | DOCX document |
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Text version
Recovery and Savings Data
| OPM | |||||
| Fraud and Abuse Recovery and Savings Data | |||||
| Year: | |||||
| Plan Name: | |||||
| Contact Person: | |||||
| Contact's Title: | |||||
| Contact's Telephone Number: | |||||
| E-Mail Address: | |||||
| Submission Date(mm/dd/yyyy): | |||||
| Total BENEFEDS | Program | Member | Other | ||
| Please place responses in shaded areas only | |||||
| Cases Opened | 0 | Only include cases opened or investigations initiated within the calendar year. | |||
| Dollars Identified as Loss | 0 | a. This segment will capture financial losses and identify the operational source of the loss as to whether the volumes were driven by the inbound (premium acceptance) or outbound (i.e. premium refunds, funds disbursement, etc.) disbursement functions. Evidence exists to support this figure; it is not an estimate. b. All estimated financial losses not included in "a" above, limited to no more than the most recent three-year period in which the fraud was determined to have occurred. Future losses are not to be included. | |||
| Dollars Recovered | 0 | This reporting segment would capture recovery of financial losses identified above across the BENEFEDS operational line of business. This figure should not be estimated or reported prior to actual receipt. | |||
| Cases Referred to Local, State, or Federal Law Enforcement Agencies | 0 | Include the number of cases referred and list the law enforcement agencies where you referred cases during the calendar year. | |||
| Cases Referred to OPM’s OIG | |||||
| Cases Resolved Administratively | 0 | Not Required | Not Required | Not Required | Provide the number of cases resolved through negotiated settlements or other administrative means. |
| Number of Arrests | Provide the number of arrests resulting from cases. | ||||
| Number of Criminal Convictions | Provide the number of criminal convictions resulting from cases. | ||||
| In what area have you found the most fraudulent behavior during the reporting period? | |||||
| * Please maintain supporting documentation for the performance statistics identified above. | |||||
| Legend | |||||
| User Entry(Number or Count) | |||||
| User Entry(Date) | |||||
| User Entry(Dollars) | |||||
| User Entry(Text) | |||||
| Automatically Calculated Field | |||||
| Fraud and Abuse Checklist for Industry Standards | |||||
| Please enter Y or N | |||||
| (Fill in entire first column; second if applicable, else leave blank) | |||||
| In-house | Subcontractor | ||||
| Anti-Fraud Policy Statement | Publish a policy statement providing your corporate strategy to address fraud and abuse and make it available to employees, enrollees, and subcontractors. | ||||
| Written Plan and Procedures | Establish written policies and procedures to be followed by all personnel for the deterrence and detection of fraud. | ||||
| Formal Training | Conduct fraud awareness training for all employees and customer facing subcontractors. Training should consist of an overview of specific fraud and abuse reporting requirements and procedures to enable personnel to identify and handle potential fraud | ||||
| Fraud Hotlines | Establish hotlines for reporting allegations of fraud, both internally and externally. Hotlines should be available to providers, enrollees, employees and others. Compliance programs should prohibit retaliation against whistleblowers. | ||||
| Education | Inform enrollees about fraudulent and abuse practices via email, website and other means. | ||||
| Security | Put safeguards in place to protect member information from unauthorized use or access. | ||||
| Legend | |||||
| Contractor Name | Text Field | ||||
| Yes | Red Text - Inappropriate entry (Y or N only) | ||||
| No | Red Text - Inappropriate entry (Y or N only) | ||||
| Notes | |||||
| Note1 | |||||
| Note2 | |||||
| Note3 | |||||
| Note4 | |||||
| Note5 | |||||
| Note6 | |||||
| Note7 | |||||
| Note8 | |||||
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| Note10 |
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