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FEHBP Administrative Sanction

The U.S. Office of Personnel Management shall debar health care providers from participating in the Federal Employees Health Benefits Program (FEHBP) under the following statutory and regulatory authorities. OPM's OIG operates these authorities under delegation from the OPM Director.

  • Federal Employees Health Care Protection Act of 1998;
  • Governmentwide Non-procurement Debarment and Suspension Common Rule;
  • Title 5, Code of Federal Regulations, Part 890, Subpart J (5 CFR 890); and
  • Title 5 of the U.S. Code, Part III, Subpart G, Chapter 89 (5 USC 8902a).

The OPM OIG Administrative Sanctions Group suspends and debars health care providers from the FEHBP, who have, among other things:

  • lost professional licenses;
  • been convicted of a crime related to delivery of or payment for health care services;
  • violated provisions of a Federal program; or
  • been debarred or suspended by another Federal agency.

Debarring or suspending these health care providers protects the integrity of the FEHBP as well as the health care interests of FEHBP participants. These sanctions assure that FEHBP funds will not be paid, either directly or indirectly, to such providers. FEHBP participants may obtain services from debarred providers, but the FEHBP will not reimburse the participant for the program share of the costs. If an FEHBP participant, however, obtains such services in good faith and without knowledge that the provider had been sanctioned, their costs may be covered.

The names of health care providers who have been sanctioned by our office are made available to FEHBP Health Insurance Carriers through the secure OPM Debar Webpage. The list of sanctioned providers is also available to the public through the General Services Administration's Government-wide list of exclusions known as the System for Award Management or SAM (www.sam.gov), formerly the Excluded Parties List System (EPLS).

As a member of the Interagency Suspension and Debarment Committee (external link) (ISDC), Executive Order 12549, we are dedicated to working with other Executive Branch organizations to provide support for Government-wide suspension and debarment programs.

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