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Supplemental Security Income: Additional Actions Needed to Reduce Program Vulnerability to Fraud and Abuse

HEHS-99-151 Published: Sep 15, 1999. Publicly Released: Sep 15, 1999.
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Highlights

Pursuant to a congressional request, GAO provided information on the Supplemental Security Income (SSI) program's vulnerability to fraud and abuse, focusing on: (1) the extent to which SSI is vulnerable to individuals who obtain eligibility by feigning disabilities with the help of middlemen and medical providers; (2) the Social Security Administration's (SSA) methods for preventing, detecting, and responding to this type of program fraud and abuse; and (3) additional strategies SSA could use to more effectively address this problem.

Recommendations

Matter for Congressional Consideration

Matter Status Comments
To address liability concerns related to maintaining lists of suspicious middlemen and medical providers and following fraud or similar fault procedures, Congress may wish to provide a limitation of the legal liability of state employees who follow SSA policies that require them to identify and document middlemen and medical providers suspected of providing misleading, inaccurate, and incomplete evidence in disability claims.
Closed – Not Implemented
According to Congressman Waxman's staff, Congressman Waxman does not intend to introduce legislation suggested in the recommendation. This staff member also checked with the House Ways and Means Committee because such legislation could fall under them. This committee also has no plans to introduce such legislation.

Recommendations for Executive Action

Agency Affected Recommendation Status
Social Security Administration The Commissioner of Social Security should study the feasibility of obtaining information on suspicious medical providers from federal, state, and private entities that face similar fraud and abuse issues as SSA does in managing the SSI program.
Closed – Not Implemented
The Office of Disability discussed this recommendation with the Office of General Counsel and the Office of Payment Benefits. They believe it is not operationally prudent to obtain information on suspicious medical providers from federal, state, or private entities because of concerns involving the Privacy Act and the Freedom of Information Act, as well as concerns that state governments and individual employees could be liable for collecting such information. SSA reiterated that their agency and state Disability Determination Services routinely use information from a variety of sources on confirmed fraudulent activities and will continue to develop new sources as appropriate.
Social Security Administration The Commissioner of Social Security should systematically track suspicious middlemen and medical providers identified by SSA staff and outside agencies, and routinely share this information throughout SSA. For example, SSA could electronically maintain information on such medical providers and middlemen and on the SSI applicants and recipients they serve. This information would help SSA: (1) determine which claims should receive increased scrutiny to prevent these applicants from improperly receiving benefits; and (2) target investigations of current beneficiaries to determine if they should be removed from the program.
Closed – Not Implemented
The Office of Disability discussed this recommendation with the Office of General Counsel and the Office of Payment Benefits. They believe it is not operationally prudent to create a system of records based on suspicious medical providers from federal, state, or private entities because of concerns involving the Privacy Act and the Freedom of Information Act, as well as concerns that state governments and individual employees could be liable for collecting such information. SSA reiterated that it is working with its Office of Inspector General (OIG) to provide an accounting of potential data sources for findings of fraud or similar fault that would be relevant to SSA's disability programs. Based on these findings, SSA's Office of Disability and Income Security Programs will work with the OIG and the Office of Systems to develop a way to make relevant information accessible to field employees.
Social Security Administration The Commissioner of Social Security should reexamine SSA's policy regarding SSA-provided interpreters for SSI applicants with the aim of determining the extent to which it is followed by field and DDS staff and its effectiveness, and whether the use of SSA-provided interpreters should be required in situations which meet certain profiles.
Closed – Implemented
SSA has reviewed its policy on the use of interpreters in the SSI program, has determined that it is correct, and is keeping it in effect. SSA provides interpreters when clients request them or when field staff suspect that an interpreter who was brought by a client is not accurately interpreting the conversation.

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Topics

Disability benefitsFraudIncome maintenance programsInternal controlsMedicaidProgram abusesSocial security benefitsSupplemental security incomeDisabilitiesDatabase management systems