Appendix A-18: Office of the Inspector General

FY 2000 Performance Report
Goal & Performance Indicators Checklist

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OPM STRATEGIC PLAN GOAL II

PROTECT AND PROMOTE THE MERIT-BASED CIVIL SERVICE AND THE EMPLOYEE EARNED BENEFIT PROGRAMS THROUGH AN EFFECTIVE OVERSIGHT AND EVALUATION PROGRAM.

As identified throughout our performance results, functions performed by the Office of the Inspector General (OIG) have significant positive impact on OPM program operations. However, setting specific target levels for each oversight activity is problematic since we do not have direct control over issues and findings that we identify. For example, a successful audit or review does not necessarily result in large financial recoveries. An audit or review without significant findings quite often indicates an effectively run program.

In addition, the measure of our impact far exceeds quantitative results. Having a strong audit and investigative presence within OPM programs is itself a substantial deterrent for fraud, waste, abuse, and mismanagement. This sentinel effect is critical in maximizing the impact of OIG operations.

Thus, while quantitative measures are an important mechanism in reporting our success, they are not the only factor in determining whether our workload goals are met.

OIG Goal 1 -- M

Independent oversight of agency programs, operations, functions, and activities is provided.

This goal was established under Strategic Goal II to ensure that OPM programs are operating in a manner which protects the integrity of the merit-based civil service and employee-earned benefits. There are four indicators to assess whether or not this goal is achieved. Of these, the second indicator was identified at the beginning of the year as most critical for achieving the goal. We met this goal by achieving positive financial impact of $105.2 million and a return on investment of $11.30 per direct program dollar spent. In addition, we maintained a strong audit and investigative presence throughout agency programs.

M Number of audits, investigations, evaluations, or reviews completed.

This is the critical measure because it reflects the real positive financial impact of Federal Employee Health Benefits Program audits and all trust fund investigations. (FY 2000 target levels were positive financial impact at $84 million and return on investment at $9).

FI = actual recoveries plus management commitment to collect findings. In addition, $65.6 million in recommended recoveries were still pending final decision at the end of FY 2000.

Return on Investment = PFI per each direct program dollar spent

M Audit cycle, average number of unaudited years, and lost audit years for FEHBP carriers.

Both Semiannual Reports to Congress (October 1, 1999 through March 31, 2000 and April 1, 2000 through September 30, 2000) were completed within the 30 day statutory deadline.

OIG Goal 2 -- M

Assist and work with our customers and stakeholders in a spirit of cooperation.

This goal was established under Strategic Goal II to ensure that OPM programs are operating in a manner that protects the integrity of the merit-based civil service and employee-earned benefits. Our ability to work with customers and stakeholders is critical for us to be as effective as possible. There are five indicators to assess whether or not this goal is achieved. Of these, the first indicator was identified at the beginning of the year as most critical for achieving the goal. We met this goal by obtaining program agreement on 72% of our recommended dollar findings within the FEHBP. In addition, OIG audits identified a significant number of issues associated with the agency’s financial statements, we successfully participated in joint quality improvement teams, and we continued to be responsive to inquiries received from our stakeholders.

M Percent of determinations made by OPM program offices that concur with FEHBP audit findings. [Critical indicator]

This is the critical measure because it relates to the efficiency and effectiveness of FEHBP audit operations. RIS agrees with the majority of audit findings that we identify, which leads to the collection of misused dollars into the FEHBP trust fund. (Although not specifically identified in the performance plan, the target level for this measure is 70%).

Percentage of recommendations agreed to and implemented by the Retirement and Insurance Service.

OIG Goal 3 -- M

Fraud against OPM programs is detected and prevented.

This goal was established under Strategic Goal II to ensure that OPM programs are operating in a manner that protects the integrity of the merit-based civil service and employee-earned benefits. Our ability to detect and prevent fraud is a critical factor in ensuring financial integrity. There are five indicators to assess whether or not this goal is achieved. Of these, indicators one and two were identified at the beginning of the year as most critical for achieving the goal. We met this goal by increasing positive investigative dispositions by approximately 25% in FY 2000. In addition, we debarred a significant number of health care providers whose actions indicated that they are a threat to the integrity of the FEHBP.

M Number of investigations resulting in a positive disposition for the agency. [Critical indicator]

This is a critical measure because the impact of these outcomes extend beyond financial recoveries and ultimately have a sentinel effect on individuals who in the future may consider committing fraud against OPM programs.

This is a critical measure because health carrier providers who are debarred are unable to participate in the FEHBP. This helps ensure that Government subscribers are protected from providers that are unethical, unprofessional, or unqualified. (Original FY 2000 target level was 2,500 common rule debarments and 500 mandatory debarments based on new legislation. However, regulations to implement the new legislation are still pending final approval. Thus we were only able to issue common rule debarments.)

No fines associated with debarment actions were assessed in FY 1998-2000. However, we will be able to assess fines when P.L. 105-266, Federal Employees Health Care Protection Act of 1998, is fully implemented. New regulations are currently in the clearance process.

M Number of referrals to DoJ

In FY 1999, the 1% not meeting time requirements were due to events such as judicial stays in bankruptcy or licensure cases which are out of the control of the OIG.

OIG Goal 4 -- M

Overall quality assurance and oversight of OPM’s programs is improved.

This goal was established under Strategic Goal II to ensure that OPM programs are operating in a manner which protects the integrity of the merit-based civil service and employee-earned benefits. There are two indicators to assess whether or not this goal is achieved. Of these, the first indicator was identified at the beginning of the year as most critical for achieving the goal. We met this goal by identifying operational weaknesses that can be addressed by the appropriate program offices.

M Change in the number of material weaknesses. [Critical indicator]

This is the critical measure because material weaknesses of OPM programs identified by the OIG are resolved, leading to improved operations. (No FY 2000 target was set, but the fewer material weaknesses identified the more secure agency resources are.)

This indicator was not achieved in FY 2000 since there is no adequate methodology to report results. OIG will drop the measure for FY 2000 because it does not report information directly related to accomplishment of the goal.