OPM health claims data collection has become a growing privacy dispute for federal employees, retirees, and their families, and a new round of scrutiny has put the issue back in the spotlight.
What OPM Wants
The issue began with an OPM information-collection proposal published in December 2025. OPM said it wanted FEHB and PSHB carriers to provide detailed service-use and cost information, including medical claims, pharmacy claims, encounter data, and provider information. The programs cover more than 8 million people, including federal employees, retirees, Postal Service employees, and eligible family members.
OPM says the information would help it oversee the programs, evaluate plan performance, negotiate contracts, and identify fraud, waste, and improper payments. The agency also says HIPAA permits carriers to disclose protected health information to health oversight agencies for authorized oversight activities.
Why Critics Object
The dispute isn’t simply about whether OPM can analyze health-plan data. It’s about how much individual-level information OPM can require carriers to provide and whether federal law actually gives the agency that authority.
The Congressional Research Service examined that question in an August report. CRS said OPM relies on its statutory authority to study and oversee the FEHB program, while carrier organizations argue that the law does not necessarily authorize OPM to require a repository containing individual claims data. CRS concluded that the legal question is unsettled and could ultimately require resolution by a court or Congress.
Privacy is another concern. OPM says it would pseudonymize records before analysts use them. But the process would begin with identifiable information, and OPM would retain the ability to connect pseudonymous records to individuals for certain purposes.
What Changed This Summer
In June, OPM published a revised System of Records Notice for its health claims database, expanding the system to include PSHB records and additional health claims information. The notice became effective upon publication, with its new routine uses taking effect July 23.
That development prompted renewed concerns from lawmakers. On Sept. 16, Sens. Adam Schiff and Mark Warner led a group of senators calling on OPM to halt the effort and raised additional privacy concerns about the collection and protection of federal workers’ health information.
The senators specifically pointed to the handling of OPM health claims data, including OPM’s ability to reconnect pseudonymized records to individuals.
Where It Stands
The important distinction is that the OPM health claims data records system now exists, but the broader dispute over OPM’s authority to require carriers to provide detailed claims data remains unresolved.
For FEHB and PSHB enrollees, the issue is ultimately about how much health information OPM can collect, how that information can be used, and how long it can be retained.
For now, those questions remain under scrutiny from lawmakers, carriers, and others, with no final legal resolution yet.
