Social Security Disability: SSA Quality Assurance Improvements Can Produce More Accurate Payments
HEHS-94-107
Published: Jun 03, 1994. Publicly Released: Jun 03, 1994.
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Highlights
Pursuant to a congressional request, GAO reviewed the quality assurance (QA) mechanisms the Social Security Administration (SSA) uses to promote accuracy and consistency in disability determinations for the Disability Insurance (DI) and Supplemental Security Income (SSI) programs.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Social Security Administration | The Commissioner of Social Security should evaluate the effectiveness of performance accuracy standards in promoting continued quality improvement, including raising the current threshold standard and considering new approaches to setting and using accuracy standards. |
Closed – Not Implemented
SSA is redesigning its disability decisionmaking process, including quality assurance (QA). Because the future QA system will be substantially different than the system reviewed by GAO, the development of higher DDS thresholds within the context recommended by GAO no longer applies.
|
| Social Security Administration | The Commissioner of Social Security should determine whether QA reviewers are correctly applying the substitution-of-judgment and probability-of-reversal rules. |
Closed – Not Implemented
SSA does not intend to conduct a special study seeking to look at the application of the substitution-of-judgment and probability-of-reversal rules. The agency believes higher priority should be given to other workloads, such as the new welfare reform requirements and increased levels of continuing disability reviews (CDR). Because the study recommended by GAO applies to the current QA system, which will soon be replaced with a substantially different system, the need to spend funds for a special study no longer seems to be justified.
|
| Social Security Administration | The Commissioner of Social Security should establish requirements to ensure that DDS have internal QA programs that effectively identify and correct the root causes of errors, including the extent to which any additional QA requirements would result in the need for increased QA staffing. |
Closed – Implemented
As part of SSA's plans to redesign the disability decisionmaking process, the agency plans to substantially redesign its system of QA. SSA plans to have an internal QA system that effectively identifies and corrects the root causes of errors up front in the development and adjudication of the case with less reliance on internal "end-of-line" case reviews.
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| Social Security Administration | The Commissioner of Social Security should develop a plan to increase the savings gained through preeffectuation reviews by increasing the proportion of cases reviewed by physician consultants. |
Closed – Not Implemented
SSA recently revised the method of selection for preeffectuation review (PER) cases to a wholly targeted sample. Consequently, the difficulty of the workload increased, leading to the need to increase medical consultant staff by up to 40 percent. Although this action was taken for purposes unrelated to the GAO recommendation, it resulted in a substantial increase in medical consultant staff, as suggested by GAO. Since SSA plans to eliminate the preeffectuation review as part of its redesign of the disability decisionmaking process, an expectation of further increases in physician consultants would not be realistic.
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Topics
Administrative errorsBeneficiariesClaims processingDisability benefitsDisability insuranceEligibility determinationsIncome maintenance programsQuality assuranceQuestionable paymentsSocial security benefitsSupplemental security incomeMedicare