Worker and Family Assistance:

More Diligent Followup Needed To Weed Out Ineligible SSA Disability Beneficiaries

HRD-81-48: Published: Mar 3, 1981. Publicly Released: Mar 3, 1981.

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The Disability Insurance program (DI), administered by the Social Security Administration (SSA), was established in 1954 to prevent the erosion of retirement benefits of wage earners who become disabled and are prevented from continuing payments into their social security account. The program was expanded in 1956 to authorize cash benefit payments to the disabled. Applications for disability benefits are processed by claims representatives who interview the claimant and prepare disability and vocational reports for use by state agencies. These agencies carry out the disability determination process under agreements with the Department of Health and Human Services (HHS). The Continuing Disability Investigation (CDI) process is the SSA method of identifying beneficiaries who may have medically recovered or regained the ability to work and assessing their continuing eligibility for disability benefits. One of the key features of the CDI process is medical reexamination. Primarily, GAO focused on SSA efforts to review the continuing eligibility of DI beneficiaries. SSA actions to correct previously noted deficiencies were also addressed.

SSA has not adequately followed up on DI beneficiaries to verify that they remain disabled. It has limited its reviews to a small percentage of beneficiaries. Most beneficiaries never have their eligibility reviewed and can remain on the rolls until they voluntarily return to work, reach age 65, or die. Even beneficiaries who have met the criteria for reexamination have not always been investigated. As a result of the limited SSA followup activity and poor management of the CDI process, as many as 584,000 beneficiaries who do not currently meet the SSA eligibility criteria may be receiving disability benefits. Furthermore, inefficiencies in the CDI program often result in program overpayments. Beneficiaries who returned to work were often paid benefits to which they were not entitled because SSA was slow to investigate and terminate their benefits. While SSA has not adequately monitored the disability rolls, it has initiated plans to increase the number and effectiveness of investigations.

Recommendations for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should study the feasibility of storing certain disability cases, perhaps those with "profiles" that indicate potential for medical recovery or work activity, in the district offices and assigning full responsibility for these cases to claims representatives. Although there would be additional personnel costs, the potential benefits to the disability program, considering that a beneficiary receives from $30,000 to $50,000 over his or her lifetime, should outweigh the costs. GAO believes that the cost effectiveness of the case management approach in selected situations should be evaluated through a pilot test.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to improve the management of the CDI process by periodically reviewing cases where overpayments were caused by the CDI process to identify and correct problems causing the overpayments.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to improve the management of the CDI process by emphasizing the importance of the CDI process and the SSA current position for reviewing the disability caseload and terminating benefits for those no longer eligible, especially by: (1) rewriting the section of the Disability Manual pertaining to continuing investigations and removing the restrictive language which may discourage SSA staff from terminating benefits; and (2) providing training to district office personnel on the intent and mechanics of the CDI process.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to improve the management of the CDI process by measuring the impact of annual wage reporting on detecting program overpayments and, if warranted, devise alternative methods to identify beneficiaries who returned to work.

    Agency Affected: Department of Health and Human Services

  5. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to improve the management of the CDI process by improving the district office and state agency capability to do thorough, timely investigations and to terminate benefits when warranted. One such measure would be to provide work activity information on the Master Beneficiary Record so the district office can access this information when a beneficiary reports that he or she has returned to work.

    Agency Affected: Department of Health and Human Services

  6. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to improve the management of the CDI process by running the Initial Determination File ("831") against the CDI file ("833") to identify and reevaluate those cases where a medical reexamination was scheduled but not done.

    Agency Affected: Department of Health and Human Services

  7. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to improve the management of the CDI process by giving priority to improving the automated continuing investigation of the disability system so that management will have a comprehensive list of overdue investigations, their age, location, and status.

    Agency Affected: Department of Health and Human Services

  8. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to begin coding the nature of the beneficiaries' impairments on the master beneficiary records.

    Agency Affected: Department of Health and Human Services

  9. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to expedite efforts to reevaluate DI rolls and to provide the necessary resources to support such efforts because of the potential savings. In this regard, SSA should use all of the additional $42 million fiscal year 1981 CDI funds to remove the nondisabled from the DI rolls and direct future budget outlays to the DI rolls until the problem is under control.

    Agency Affected: Department of Health and Human Services

 

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