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Disability Insurance: SSA Should Strengthen Its Efforts to Detect and Prevent Overpayments

GAO-04-929 Published: Sep 10, 2004. Publicly Released: Oct 19, 2004.
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Highlights

The Social Security Administration's (SSA) Disability Insurance (DI) program is one of the nation's largest cash assistance programs for disabled workers. In fiscal year 2003, the DI program provided about $70 billion in financial assistance to approximately 7.5 million disabled workers, their spouses, and dependent children. This program has grown in recent years and is poised to grow further as the baby boom generation ages. The Senate Committee on Finance asked GAO to (1) determine the amount of overpayments in the DI program, particularly those attributable to earnings or work activity, and (2) identify any vulnerabilities in SSA's processes and policies for verifying earnings that may contribute to work-related overpayments.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Social Security Administration To enhance SSA's ability to detect and prevent overpayments in the DI program, the Commissioner of Social Security should initiate action to develop a data sharing agreement with the Office of Child Support Enforcement to conduct batch-file periodic computer matches with the National Directory of New Hires (NDNH). Such matches would provide SSA with more timely data to help the agency systematically identify DI beneficiaries who are most likely to incur overpayments. Such a tool could also allow SSA to perform a one-time, comprehensive match against all DI beneficiary records to identify individuals who may be overpaid but have not yet been detected.
Closed – Implemented
SSA has a signed agreement with HHS's Office of Child Support Enforcement Administration to use the National Directory of New Hires (NDNH) database for periodic computer matching. This data agreement is aimed at identifying possible earnings related overpayments in the DI program.
Social Security Administration To enhance SSA's ability to detect and prevent overpayments in the DI program, the Commissioner of Social Security should consider developing an enhanced screening mechanism that would enable the agency to more effectively identify DI beneficiaries who are most likely to incur earnings-related overpayments. This would help the agency make more efficient use of limited staff and budgetary resources.
Closed – Implemented
In FY 2005, SSAs Continuing Disability Review Enforcement Operation (CDREO) was using earnings data posted to the Disability Control File (DCF) as well as those posted to the Master Earnings File (MEF) to generate alerts based upon a set of rules that identify cases based on specific characteristics. The additional use of the DCF allows the CDERO system to screen out cases where a beneficiary has significant earnings, but a determination has already been made on those earnings.
Social Security Administration To enhance SSA's ability to detect and prevent overpayments in the DI program, the Commissioner of Social Security should study the potential for creating an alert system similar to that used in the SSI program for alerting field offices about recipients at high risk for earnings-related overpayments. Such a system would allow SSA to notify field offices and program service centers about beneficiaries the agency identifies as most likely to incur large overpayments.
Closed – Not Implemented
When the Continuing Disability Review Enforcement Operation (CDREO) identifies disability beneficiaries with significant earnings, it signals to the Disability Control File (DCF) for work activity control purposes. If there is no current work activity development pending, the CDREO posts the pending action to the DCF and generates an alert to the relevant field office or program service center to process the Continuing Disability Review. The DCF then controls these issues to completion. However, this alert system does not identify individuals who may be most likely to incur a large overpayment. There is no prioritization or flagging of cases alerted to differentiate them. SSA does not create categories of cases by the size or the potential for a large overpayment.
Social Security Administration To enhance SSA's ability to detect and prevent overpayments in the DI program, the Commissioner of Social Security should consider ways to improve the accuracy and usefulness of existing management information data. Improvements may include modifying how the agency measures the age of work CDR cases to more accurately reflect how long they are in process.
Closed – Implemented
SSA has made some improvements for providing information on aged cases. As of August 2003, the Management Information Systems Facility now contains a "Pending" query screen that provides the CDR age-in-operations, rather than age-in-location, enabling users to select the oldest cases first. However, the agency acknowledged that few safeguards existed to prevent double-counting of work Continuing Disability Review (CDR) cases. To address this issue, SSA developed a new computer system called the Social Security Unified Measurement System (SUMS) that captures workload counts and employee time more consistently.
Social Security Administration To enhance SSA's ability to detect and prevent overpayments in the DI program, the Commissioner of Social Security, once the eWork system is fully implemented, should consider how it could be used to help the agency create performance goals for its work CDR workload.
Closed – Not Implemented
SSA agrees that once eWork has been implemented on a national basis and sufficient time has elapsed to allow users to become proficient in its use, it should consider using the data in creating agency performance goals for its work CDR workloads.

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Topics

BeneficiariesData integrityDebtDisability benefitsDisability insuranceFederal employee disability programsManagement information systemsOverpaymentsPolicy evaluationPolicies and procedures