Social Security:

Payment Accuracy Rates Are Overstated

HRD-88-10: Published: Oct 29, 1987. Publicly Released: Oct 29, 1987.

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GAO examined the Social Security Administration's (SSA) Retirement and Survivors Insurance (RSI) program, to determine the: (1) adequacy of SSA payment measurement procedures; (2) accuracy of error rates annually reported for the program; and (3) effects of errors on beneficiaries.

GAO found that: (1) although the processes SSA used to measure errors and determine payment accuracy rates were adequate, SSA did not include all of the errors it detected when it calculated accuracy rates; (2) because SSA excluded errors that occurred more than 4 years ago, underpayments, and monthly errors less than $5, its reported case error rate was about one-half of the actual rate; (3) SSA based its annual payment accuracy rates only on total dollars paid, instead of the incidence of cases in error, and did not include underpayments or certain overpayments; and (4) SSA regional assessment offices had disparities in their detection rates. GAO calculated that: (1) SSA made erroneous payments in one of six cases for an average of 5 years; (2) 60 percent of the errors were underpayments averaging $591; (3) the overpayments averaged $1,069; (4) the error amounts averaged 5 percent of total benefits paid in each case; and (5) routine SSA procedures would not have detected these errors.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: SSA agreed with most of this recommendation. Effective with data for the period ending December 31, 1987, SSA began reporting data on case error rates, whether SSA or beneficiaries caused errors, and excess as well as underpayments. However, it has not reported errors below $5 a month and those barred from correction by law. SSA believes reporting these errors would distort their importance.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to report all categories of detected RSI program errors. Such reporting should include: (1) case accuracy rates as well as dollar accuracy rates; (2) all errors detected during the sample period; and (3) the incidence of errors attributed to SSA.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: SSA restudied 156 cases from two regions identified in the report as having possible problems. Cases that were most prone to error were reexamined. SSA found no errors. Based on review, SSA believes that both regions are performing reviews as well as eight other regions. SSA believes that demographics and economic characteristics are responsible for low-error rates in these two regions.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to determine the extent to which regional assessment offices may not be identifying errors during the Payment Accuracy Study, and the effect such undetected errors have on the payment accuracy rate.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Not Implemented

    Comments: SSA studied the performance of two regions, as recommended. Its study found no reason to change the monitoring of regional quality review analysis.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to determine what additional verification or changes may be warranted in the monitoring of regional quality review analysis.

    Agency Affected: Department of Health and Human Services

 

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