OPM Responds to Concerns Over Plan to Access to FEHB/PSHB Medical Records

In a blog posting, OPM director Scott Kupor has now said that the information will be treated in a way so that it “cannot be mapped back to any plan participant” by OPM or personnel offices. Image: O. Kalacheva/Shutterstock.com
By: FEDweek Staff

OPM has sought to allay privacy concerns about its plan to access detailed medical information on FEHB/PSHB enrollees, with one of the organizations that raised such concerns—the National Active and Retired Federal Employees Association—cautiously optimistic that OPM is addressing them.

In a Federal Register notice posted in December, but which only drew attention months later in April, OPM proposed to gain access to carriers’ records including office visits, treatment, prescriptions and other medical information, without a requirement that they withhold personally identifying information.

NARFE said in April that the notice “fails to explain adequately why OPM needs the data, how it will use it, how it will secure it, and what safeguards will be in place to protect the privacy of federal employees and retirees.” The AFGE union meanwhile said the data “could be used to identify employees who have sought care that this administration has made a specific target of its policy agenda, including reproductive health care and gender-affirming treatment.”

Separate letters to OPM from about a dozen House and Senate Democratic members raised similar concerns, with the Senate letter saying that the risk of such information being misused “cannot be overstated.”

In a blog posting, OPM director Scott Kupor has now said that the information will be treated in a way so that it “cannot be mapped back to any plan participant” by OPM or personnel offices.

He said that OPM’s inspector general’s office—which has access to such information for its audits of health plans and carriers—“will provide an encrypted copy of that data to OPM – but only after stripping out names, social security numbers, phone numbers, addresses (except for ZIP codes), and other personally identifiable data. The only member-level PII fields that will remain in the data that OPM receives will be our member’s ZIP codes, year of birth, and their member ID.”

He said that OPM further will replace the member ID with random numbers and characters and that the data “will remain in a secure, separate environment, encrypted at rest and protected with our IT security best practices.”

Kupor said that while IG audits have been valuable in uncovering fraudulent activity in the health-care program such as kickbacks and overbilling, those audits happen after the fact. “OPM ought to be able to identify mis-billings and inappropriate delivery of services by providers when those actions happen. That way, we can recoup any lost dollars immediately and, if necessary, terminate providers,” he said.

In a statement to FEDweek, NARFE said that OPM’s “background explanation in its official notice was about 100 words, and clearly inadequate. In contrast, OPM Director Kupor’s blog post provides about a 1,500 word explanation of OPM’s request for data, and it provides some helpful clarifying information regarding how OPM intends to use the data to help identify fraud and reduce costs for plan participants. But it remains a blog post.”

“We look forward to learning more about OPM’s plans to utilize, secure and protect the privacy of the data if efforts move forward,” it said.

Separately, OPM recently issued a notice to carriers reminding them of fraud prevention and detection programs required of them, and finalized rules seeking to address the long-running issue of ineligible persons being covered, by imposing new requirements for proof of eligibility, and reinforcing policies on removing persons found to be ineligible.

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