SSA provides benefits to individuals with disabilities through two main programs: DI and SSI. Individuals are generally considered disabled if they are unable to do their previous work and, considering age, education, and work experience, are unable to engage in any other kind of substantial gainful work and their disability has lasted or is expected to last at least 1 year or is expected to result in death. See table 1 for additional key features and requirements of the DI and SSI programs. SSA’s process for determining eligibility for disability benefits—which is generally the same for DI and SSI claimants—starts when an individual submits a claim to SSA. First, an SSA field office employee reviews the claim to determine whether the claimant meets SSA’s nonmedical eligibility requirements and, if so, forwards the claim to a state Disability Determination Services (DDS) office. A DDS examiner then reviews the claim to make a determination of medical eligibility. If the claim is denied, the claimant has several opportunities for appeal within SSA, starting with a reconsideration at the DDS level and then a hearing before an administrative law judge. Claims at all levels for which the claimant is determined to be eligible for DI or SSI benefits, also called favorable claims, are forwarded to other SSA offices for payment. See figure 1 for an overview of SSA’s eligibility determination process for disability programs. SSA has policies and guidance on how SSA and DDS employees should document and report suspected fraud. According to SSA’s policy, fraud generally occurs when an individual makes or causes to be made false statements of material facts or conceals such facts for use in determining rights to benefits, with intent to defraud. SSA guidance includes a list of factors that may indicate potential fraud for field office staff and DDS examiners to consider when processing disability claims. According to SSA’s policy, employees should gather enough information to either remove suspicion or determine that there is potential fraud. If they determine that potential fraud exists, they should refer the case to the SSA OIG. They are also expected to develop the referral with as much information as possible, including who allegedly committed fraud, how, and when. See figure 2 for an overview of SSA’s fraud referral process. To help investigate some potential disability fraud cases, the OIG and SSA collaborate through Cooperative Disability Investigation (CDI) and fraud examination units: CDI units are staffed with a mix of SSA, DDS, and OIG staff, as well as state or local law-enforcement officers, to obtain evidence when potential fraud is suspected. CDI investigators often work undercover. As of January 2017, there were 39 CDI units covering 33 states, the District of Columbia, and Puerto Rico. Fraud examination units are staffed by SSA employees with disability determination expertise. Prompted by OIG requests and at the direction of SSA’s Operations component, they review claims to help detect patterns of disability fraud perpetrated by third parties such as physicians, attorneys, or claimant representatives. As of January 2017, fraud examination units were located in New York City, San Francisco, and Kansas City, but each of the three units works on cases from anywhere in the nation. SSA’s OAFP provides centralized oversight and accountability of the agency’s antifraud initiatives. The OAFP’s efforts include managing fraud risks in all of SSA’s programs including its disability programs. SSA’s National Anti-Fraud Committee (NAFC) provides a forum for agency executives to collaborate on antifraud strategies and serves as an advisory board for the OAFP in determining what initiatives to monitor, among other things. The NAFC is cochaired by SSA’s Deputy Commissioner for Budget, Finance, Quality, and Management and the agency’s Inspector General. All SSA deputy commissioners are voting members of the NAFC. The Associate Commissioner for the OAFP, who reports to the Deputy Commissioner for Budget, Finance, Quality, and Management, serves as the agency’s chief fraud prevention officer and is a nonvoting member of the NAFC. The NAFC is at a higher level than the OAFP and has cross-agency authority. See figure 3 for an overview of SSA’s antifraud management structure. According to federal standards and guidance, executive-branch agency managers are responsible for managing fraud risks and implementing practices for combating those risks. Federal internal control standards call for agency managers to assess fraud risks as part of their internal control activities. The Fraud Risk Framework provides a comprehensive set of leading practices that serves as a guide for agency managers to use when developing efforts to combat fraud in a strategic, risk-based way. The Fraud Risk Framework describes leading practices in four components: 1. Commit—Commit to combating fraud by creating an organizational culture and structure conducive to fraud risk management; 2. Assess—Plan regular fraud risk assessments and assess risks to determine a fraud risk profile; 3. Design and Implement—Design and implement a strategy with specific control activities to mitigate assessed fraud risks and collaborate to help ensure effective implementation; and 4. Evaluate and Adapt—Evaluate outcomes using a risk-based approach and adapt activities to improve fraud risk management. In addition, the Fraud Risk Framework reflects activities related to monitoring and feedback mechanisms, which include ongoing practices that apply to all four components, as depicted in figure 4. In July 2016, the Office of Management and Budget published guidance about enterprise risk management and internal controls in federal executive departments and agencies. Among other things, this guidance affirms that managers should adhere to the leading practices identified in the Fraud Risk Framework. In addition, the Fraud Reduction and Data Analytics Act of 2015, enacted in June 2016, requires the Office of Management and Budget to establish guidelines for federal agencies to establish controls to identify and assess fraud risks and design and implement antifraud control activities. The act requires the Office of Management and Budget to incorporate the leading practices from the Fraud Risk Framework in the guidelines. Further, the act requires federal agencies to submit to Congress a progress report each year for 3 consecutive years on the implementation of the controls established under the Office of Management and Budget guidelines, among other things. SSA has taken steps to establish an organizational culture and structure that are conducive to managing fraud risks in its disability programs. The agency has demonstrated a senior-level commitment to combating fraud in its disability programs and has worked to involve all levels of the agency in setting an antifraud tone. For example, in April 2014, SSA reestablished the NAFC to provide support for national and regional antifraud activities. The NAFC is composed of deputy commissioners from across the agency and other SSA executives who meet at least quarterly, which helps to demonstrate a senior-level commitment to combating fraud—one of the Fraud Risk Framework’s leading practices. The NAFC invites regional staff to its regular meetings and to an annual conference to report on the progress of SSA’s antifraud initiatives, which helps involve multiple levels of the agency in setting an antifraud tone— another leading practice in the Fraud Risk Framework. SSA also demonstrated a commitment to combating fraud at all levels of the agency when it implemented the first annual mandatory antifraud training in 2014 for all SSA and DDS staff. As discussed further below, the training describes indicators of potential fraud and instructs staff on how to report it. According to SSA officials, 97 percent of SSA employees and all DDS employees except for those on extended leave completed the most recent annual antifraud training. SSA further demonstrated a commitment to antifraud efforts by conducting a study to evaluate its fraud risk management approach and shortly thereafter establishing a dedicated antifraud office within the agency. SSA contracted with a consulting firm in April 2014 to identify leading practices for managing fraud risks and, according to SSA officials, sought input from other federal agencies about their efforts. The consulting firm’s study identified the importance of establishing a dedicated antifraud office. SSA subsequently established the OAFP in November 2014. The OAFP is responsible for coordinating antifraud efforts, developing antifraud policies, and creating and implementing fraud mitigation plans across SSA, among other things. These responsibilities are consistent with leading practices. According to the Fraud Risk Framework, agency managers can show commitment to combating fraud by creating a structure with a dedicated entity to lead fraud risk management activities and coordinate antifraud initiatives across the agency. In addition, leading practices call for the designated antifraud entity to, among other things, serve as the repository of knowledge on fraud risks and controls and lead or assist with trainings and other fraud-awareness activities. Since the OAFP was established, the office has performed several of these activities. For example, the OAFP has taken steps to coordinate antifraud initiatives across SSA by gathering information about progress on the initiatives, and has helped create antifraud training materials for the agency. In addition, the OAFP formed a committee in 2015, made up of associate commissioners from across the agency, to work on antifraud initiatives. SSA’s Acting Commissioner has reinforced SSA’s commitment to combating fraud by communicating the importance of antifraud efforts in multiple ways. For example, the Acting Commissioner highlighted SSA’s antifraud efforts in a March 2015 virtual town hall meeting, which more than 27,000 SSA staff participated in by video or in person, and issued a “Commissioner’s broadcast” to all employees, encouraging staff to provide suggestions for combating fraud via an e-mail box launched in March 2014. From March 2014 through the end of December 2016, SSA received 399 suggestions and implemented 8 of them by, for example, adding examples and a cross-reference in SSA’s operations manual to help employees identify potential beneficiary fraud.