Supplemental Security Income: Organizational Culture and Management Inattention Place Program at Continued Risk
Released: 1998-04-21T00:00:00

Letter

Background

activity because of an impairment expected to result in death or last at least 12 months.

The process SSA uses to determine an applicant’s financial eligibility for SSI benefits involves an initial determination when someone first applies and periodic reviews to determine whether the recipient remains eligible. SSI recipients are required to report significant events that may affect their financial eligibility for benefits, including changes in income, resources, marital status, or living arrangements—such as incarceration or residence in a nursing home. To verify that the information provided by a recipient is accurate, SSA generally relies on matching data from other federal and state agencies, including Internal Revenue Service 1099 information, Department of Veterans Affairs benefits data, and state-maintained earnings and unemployment data. When staff find discrepancies between income and assets claimed by a recipient and the data from other agencies, they send notices to SSA field offices to investigate further.

To determine a person’s medical qualifications for SSI as a disabled person, SSA must determine the individual’s capacity to work as well as his or her financial eligibility. To determine whether an applicant’s impairment qualifies him or her for benefits, SSA uses state Disability Determination Services (DDS) to make the initial assessment. Once a recipient begins receiving benefits, SSA is required to periodically conduct Continuing Disability Reviews (CDR) to determine whether a recipient’s disabling condition has improved.

Inattention to Verifying Recipients’ Initial and Continuing Eligibility Has Had Negative Effects

nursing home residents continued to receive full SSI benefits. These erroneous payments occurred because recipients and nursing homes did not report admissions and SSA lacked timely and complete automated admissions data. SSA has estimated that overpayments to recipients in nursing homes may exceed $100 million annually.

To help verify that recipient financial information is correct, SSA generally relies on computer matching with other federal and state agencies. In many instances, these matches allow SSA to detect information recipients fail to report. However, SSA’s data matches are not always the most effective means of verifying recipient financial status, because the information is often quite old and sometimes incomplete. In 1996, we estimated that direct on-line connections (as opposed to computer matching) between SSA’s computers and databases maintained by state agencies—welfare benefits, unemployment insurance, and workers’ compensation benefits—could have prevented or quickly detected $34 million in SSI overpayments in one 12-month period. In 1998, we reported that SSA’s computer matches for earned income rely on data that are from 6 to 21 months old, allowing overpayments to accrue for this entire period before collection actions can begin. We concluded that newly available Office of Child Support Enforcement (OCSE) databases maintained by SSA could prevent or more quickly detect about $380 million in annual SSI overpayments caused by unreported recipient income. These databases include more timely state-reported information on newly hired employees, as well as the quarterly earnings reported for these individuals. However, to date, SSA has put only minimal effort into incorporating these data into its financial verification processes. In the same report, we also concluded that opportunities existed for SSA to prevent almost $270 million in overpayments by obtaining more timely financial account information on SSI beneficiaries. This could be accomplished if SSA moves to obtain access to a nationwide network that currently links all financial institutions. Such information would help ensure that individuals whose bank accounts would make them ineligible for SSI do not gain eligibility. program weakness. Staff and managers were particularly concerned that recipients were not reporting changes in their living arrangements that could result in lower SSI payments. When determining SSI eligibility, SSA’s claims processors are required to apply a complex set of policies designed to document individuals’ living arrangements and any additional support they may be receiving from others. For many years, SSA’s quality reviewers have deemed this process to be highly prone to error, susceptible to manipulation, and a major source of SSI overpayments. In one field office we visited, staff identified a pattern of activity involving recipients who, shortly after becoming eligible for benefits, claim that they have separated from their spouse and are living in separate residences. Staff suspected that these reported living arrangement changes occurred as married recipients became aware that separate living arrangements would substantially increase their monthly benefits. Staff also suspected that several local attorneys were preparing “boiler plate” separation agreements for these individuals to help them qualify for higher benefits. However, because of a lack of field representatives to investigate these claims, only rarely were these cases closely reviewed or challenged.

During our review, we identified several internal and external studies of SSI living arrangement issues conducted over many years. Some of these studies recommended ways to simplify the process by eliminating many complex calculations and thereby making it less susceptible to manipulation by recipients. Others contained recommendations for making the SSI program less costly to taxpayers by requiring that benefit calculations be subject to maximum family caps or economies of scale or both when two or more recipients reside in the same household. In 1989, SSA’s Office of the Inspector General (OIG) reported that a more simplified process that applied an economies-of-scale rationale to all SSI recipients living with another person would result in fewer decisional errors and reduce annual overpayments by almost $80 million. However, the OIG concluded that such a change would require legislative action. Despite these studies, and the potential program savings associated with addressing this issue, we could find no evidence that SSA has ever acted on the recommendations or submitted proposals for changing laws governing current living arrangement policies. benefits and is expanding its use of on-line state data to obtain more real-time applicant and recipient information. However, progress has been slow and SSA still does not adequately use on-line access as an overpayment detection and prevention tool. SSA has opted instead to use the on-line connections it does have primarily as a tool for helping staff with claims processing. In regard to SSI recipients residing in nursing homes, SSA plans to use a newly developed Health Care Financing Administration system to more effectively capture admissions to these and other facilities. However, automated nursing home data already available in all state Medicaid agencies could be used now by SSA to identify SSI recipients living in nursing homes within 1 to 3 months of admission. SSA’s failure to use this information while waiting for the implementation of an alternative system has left the SSI program open to continued abuse and millions of dollars in potential overpayments. Finally, SSA told us that it is continuing to study SSI living arrangement policies and may ultimately consider proposing legislative changes to reduce the complexity of the process and prevent overpayment of program dollars to recipients. Nevertheless, more than two decades after implementation of the SSI program, this issue still has not been addressed effectively.

SSA Overpayment Collections Have Received Inadequate Agency Attention

In addition to problems associated with SSA’s verification of important SSI eligibility information, SSA has not placed adequate priority on recovering overpayments, which reached $2.6 billion by 1997. Statistics show that, on average, SSA collects only about 15 percent of all outstanding overpayments. Thus, over time, SSA’s collection actions have been outpaced by outstanding SSI debt, which is becoming an increasingly larger portion of all debt owed to the agency. Between 1989 and 1997, SSI debt carried on SSA’s books more than doubled to about $2.6 billion. Although annual overpayment recoveries also increased during this period, the gap between what is owed SSA and what is actually collected each year has continued to widen. recovering overpayments from those who have left the program. Sustained use of TRO may also serve a larger purpose of deterring recipients from misreporting important eligibility information to SSA in the future. Waiting many years to move forward with this important overpayment recovery tool has likely cost the SSI program millions of dollars in SSI collections.

Another reason SSI overpayment debt has increased is that SSA does not have and has not adequately pursued the authority to use more aggressive debt collection tools, including the ability to administratively intercept other federal benefit payments recipients may receive, notify credit bureaus of an individual’s indebtedness, use private collection agencies, and charge interest on outstanding SSI debt. In 1995, we reported that welfare programs that used a broad range of collection tools, such as those listed above, experienced better rates of overpayment recovery than programs that did not. Although the agency lacks statutory authority to use these tools to pursue SSI overpayments, in a recent testimony, SSA management acknowledged that such tools are valuable in collecting program overpayments. However, SSA has not yet advocated or sponsored any such legislative proposals for change.

SSA to make more effective determinations as to who can afford to repay at a higher level and who cannot.

Finally, SSA is not adequately using overpayment penalties as a means of ensuring that recipients comply with reporting policies. Overpayment penalties range from $25 to $100. However, SSA’s own reviews have found that overpayment penalties are rarely used by staff, even for individuals who have a history of failure to make timely reports of earnings or living arrangement changes. Our analysis of data from all 10 of SSA’s regions also confirmed that SSI overpayment penalties are rarely applied. In one 12-month period, SSA detected about 2.3 million overpayment instances totalling $1.2 billion in erroneous payments. However, less than $80,000 in penalties were actually assessed and only $8,000 was collected. These infrequent penalty assessments provide little incentive for recipients to change their reporting habits.

SSI Program Remains Vulnerable to Fraud and Abuse

In prior work, we identified several SSI program areas subject to fraud and abuse. For example, in 1995 we reported that “middlemen” were facilitating fraudulent SSI claims by providing translation services to non-English-speaking individuals applying for SSI. These individuals often coached claimants on appearing to be mentally disabled, used dishonest health care providers to submit false medical evidence to SSA, and provided false information on claimants’ medical and family history. The following year, we reported that between 1990 and 1994, approximately 3,500 recipients admitted transferring ownership of resources such as cars, cash, houses, land, and other items valued at an estimated $74 million to qualify for SSI benefits. This figure represents only resource transfers recipients actually reported to SSA. Although these transfers are legal under current law, using them to qualify for benefits has become an abusive practice that raises serious questions about SSA’s ability to protect taxpayer dollars from waste and abuse. We estimated that for the cases above, eliminating asset transfers would have saved $14.6 million in program expenditures. The Congressional Budget Office (CBO) has estimated that more than $20 million in additional savings could be realized through 2002 by implementing an asset transfer restriction.

Although SSI represents less than 8 percent of SSA’s total expenditures, the number of fraud referrals received by OIG is significant. For example, between November 1996 and July 1997, SSA’s fraud Hot-Line received 12,680 allegations of fraud. When compared with SSA’s other programs, SSI fraud referrals represented about 37 percent of all allegations. Since becoming an independent agency in 1995, SSA has begun to take more decisive action to address SSI program fraud and abuse. For example, the number of OIG investigators has nearly tripled from 76 to 227 headquarters and field agents, and in 1997, combatting program fraud and abuse became a key agency goal. Last year, SSA also established National and Regional Anti-Fraud Committees to better identify, track, and investigate patterns of fraudulent activity. In addition, several OIG “pilot” investigations are under way that are aimed at detecting fraud and abuse earlier in the SSI application process. According to SSA, this new emphasis on early prevention represents a major shift away from how it has traditionally dealt with SSI fraud and abuse. Finally, SSA recently established procedures to levy civil and monetary penalties against recipients and others who make false statements to obtain SSI benefits.

It is too early to tell what immediate and long-term effects SSA’s activities will have on detecting and preventing SSI fraud and abuse. However, many years of inadequate attention to program integrity issues have fostered a strong skepticism among both headquarters and field staff that fraud detection and prevention is an agency priority. In fact, SSA’s own studies show that many staff believe OIG does not adequately review fraud referrals or provide feedback on the status of investigations. Others noted that constant agency pressure to process more claims impeded the thorough verification of recipient-reported information and the development of fraud referrals. Staff were also concerned that SSA has not developed office work credit measures, rewards, and other incentives to encourage them to devote more time to developing fraud cases—a process that often takes many hours. Our review of SSA’s work credit system confirmed that adequate measures of the activities and time necessary to develop fraud referrals have not been developed. Nor has SSA developed a means of recording and rewarding staff for time they spend on developing fraud cases. As a result, many staff may be unwilling to devote the necessary time. It thus appears that SSA’s new anti-fraud activities and its current work credit system may be working against each other.

Conclusions

have totalled $1.8 billion, including $562 million in 1997 alone. When these write-offs are combined with the SSI debt currently owed the agency, the actual amount of SSI overpayments exceeds $4.4 billion. This is a significant amount of taxpayer money that will likely never be recovered. In light of the magnitude of SSI overpayments and outstanding debt, it is important that actions be taken to address the long-standing problems we have discussed today.

To a great extent, SSI program problems are attributable to an ingrained organizational culture that has historically placed a greater value on quickly processing and paying SSI claims than on controlling program expenditures. More recently, SSA has acknowledged the need to strike a better balance between serving the public and protecting the financial integrity of its programs. As noted throughout this testimony, SSA is also taking steps to address some of the weaknesses in the SSI program. However, reversing how the SSI program has traditionally operated will depend heavily on SSA’s willingness to move beyond recognizing that a rebalancing of program priorities is long overdue. SSA management must enhance and demonstrate its commitment to controlling program payments by seeking out the most timely and complete automated sources for verifying recipient eligibility information. SSA should also aggressively pursue SSI overpayments once they occur by using the collection tools currently available to it and working with the Congress to obtain legislative authority for those it does not have. SSA should also sustain and expand fraud-prevention initiatives that have been shown to be effective. Finally, SSA needs to use its office work credit and measurement system to hold staff and managers accountable for protecting program funds and should find better ways to reward those who do so. however, the SSI program will remain open to those who believe they can manipulate the program without penalty.

This concludes my prepared statement. I will be happy to respond to any questions you or other Members of the Subcommittee may have.

Related GAO Products

Supplemental Security Income: Opportunities Exist for Improving Payment Accuracy (GAO/HEHS-98-75, Mar. 27, 1998).

SSA’s Management Challenges: Strong Leadership Needed to Turn Plans Into Timely, Meaningful Action (GAO/T-HEHS-98-113, Mar. 12, 1998).

Supplemental Security Income: Timely Data Could Prevent Millions in Overpayments to Nursing Home Residents (GAO/HEHS-97-62, June 3, 1997).

High-Risk Program: Information on Selected High-Risk Areas (GAO/HR-97-30, May 16, 1997).

Supplemental Security Income: Long-standing Problems Put Program at Risk for Fraud, Waste, and Abuse (GAO/T-HEHS-97-88, Mar. 4, 1997).

High-Risk Series: An Overview (GAO/HR-97-1, Feb. 1997).

High-Risk Series: Quick Reference Guide (GAO/HR-97-2, Feb. 1997).

Supplemental Security Income: SSA Efforts Fall Short in Correcting Erroneous Payments to Prisoners (GAO/HEHS-96-152, Aug. 30, 1996).

Supplemental Security Income: Administrative and Program Savings Possible by Directly Accessing State Data (GAO/HEHS-96-163, Aug. 29, 1996).

Supplemental Security Income: Some Recipients Transfer Valuable Resources to Qualify for Benefits (GAO/HEHS-96-79, Apr. 30, 1996).

Supplemental Security Income: Disability Program Vulnerable to Applicant Fraud When Middlemen Are Used (GAO/HEHS-95-116, Aug. 31, 1995).

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