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OIG Update [3]

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  • Kevin
    From Peace Corps OIG Semiannual Report to Congress, April 1 - September 30, 2007 OIG Investigations of Federal Employees Compensation Act Recipients At
    Message 1 of 1 , Jan 7, 2009

      From Peace Corps OIG Semiannual Report to Congress, April 1 - September 30, 2007

      "OIG Investigations of Federal Employees' Compensation Act Recipients"

      At present, the Peace Corps has approximately 1,300 open Federal Employees'
      Compensation Act (FECA) claims. The Agency spends approximately $11 million
      in FECA claims for former Volunteers and staff who were injured or became ill on
      the job. Unlike other Federal entities, per Section 10.730 Worker's Compensation
      Programs, "[a]ny injury sustained by a volunteer or volunteer leader while he or she is
      located abroad shall be presumed to have been sustained in the performance of duty,
      and any illness contracted during such time shall be presumed to be proximately
      caused by the employment." This also includes any pre-existing condition that may
      have been aggravated by Peace Corps service. In addition, the Peace Corps' five-year
      rule and Volunteer special status under the FECA program limit the possibility that
      these individuals will return to work.

      During the first quarter of fiscal year 2005, the OIG, in coordination with the Peace
      Corps Office of Medical Services (OMS) launched a fraud prevention initiative for
      claims paid under FECA. The OIG also developed a partnership with the Office of
      Inspector General of the U.S. Department of Labor.

      Our joint review of FECA claims with OMS includes determination of medical
      status as it relates to the claimants ability to return to work. We also review the
      medical status with regard to potential costs of the claim to the Agency both in
      medical and disability costs. The OIG reviews claims with OMS staff to determine
      if further investigation is required to confirm the status of the claimant. Past reviews
      and investigations by the OIG have resulted in the identification of claimants
      who had not disclosed supplemental income, change of address, and disability
      overpayments. The OIG has also taken an active part in investigating physicians with
      questionable billing practices.

      As a part of our efforts to monitor the FECA recipients, OIG agents continue to
      coordinate with the post service nurse of the Agency's Office of Medical Services
      to investigate claimants that are suspected of abusing and/or defrauding the
      FECA program. OIG agents regularly travel to FECA district offices to conduct
      record reviews. We also perform surveillances, interviews, and other investigative
      activities on individuals that have been flagged for unusual patterns of behavior or
      circumstances. The following are the highlights of FECA investigatory work during
      this reporting period.

      • We concluded a two-year investigation which included target letters, surveillance,
        direct meetings, and other investigative activities regarding a FECA recipient
        who was ultimately found to be gainfully employed and teaching overseas.
        The recipient had been receiving benefits since 1992. We coordinated the
        investigation with OMS and the Office of Workers' Compensation Program
        (OWCP). The investigation resulted in the Department of Labor (DOL)
        terminating the claim. Annual savings to the Agency was $18,996.00 and an
        actuarial savings on the claim was estimated to be $607,872.00.
      • We reviewed the FECA benefits of a former Volunteer who had been injured and
        institutionalized since 2003. DOL is resolving an OIG agent's finding that the
        attending hospital is in possession of overpayments of approximately $58,000
        dating back to calendar year 2003. Additionally, a review of records by the OIG
        divulged a payment error by DOL which may have resulted in $10,596.00 in
        recipient benefits going to the wrong caregiver.
      • In June 2007, two OIG agents traveled to Districts 9 and 3 to follow-up on
        FECA claimants. The two agents found the residence and place of employment
        of one individual. While interviewing the claimant at her place of employment,
        the agents obtained valuable information. The investigation is still pending.
      • Surveillance was conducted on another individual in District 9. The OIG is
        awaiting the results of a mail cover recently placed on the individual's mail. The
        investigation is still pending.
      • We coordinated with the Department of Labor's OIG on an investigation of
        claimant that has been deceased for over 18 months. The joint investigation
        revealed that deposited FECA payments were accessed by a family member
        who failed to notify DOL/OWCP that the claimant was deceased. From our
        investigation and initiatives, DOL is negotiating full restitution in the amount
        of $20,000 from the family member who fraudulently utilized the deceased
        claimant's funds. The information regarding this case was presented to the U.S.
        Attorney's Office for prosecution, but declined due to the low dollar threshold.
      • Two OIG agents traveled to southern Paraguay to conduct investigative activities
        on a claimant that had been flagged for high compensation benefits and low
        medical benefits. This case is still pending.
      • The OIG flagged two FECA claimants that had high compensation benefits
        and low medical costs. During interviews, OIG agents concluded that these
        individuals do have legitimate FECA claims. Therefore, no further investigative
        action is required at this time. These investigations have been closed.
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