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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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.

GAO noted that: (1) although the number of people who have feigned injuries or illnesses to obtain SSI benefits is unknown, the SSI program is vulnerable to this type of fraud and abuse; (2) many SSI beneficiaries' impairments are difficult to objectively verify; (3) from a sample file of beneficiaries--developed by SSA to research characteristics of the SSI population--GAO found that more than 60 percent had such impairments, including psychoses, schizophrenia, and other mental disorders, as well as a range of physical disorders; (4) in addition, providers who have been investigated for defrauding Medicaid, Medicare, or private insurance companies furnished at least some portion of the supporting medical evidence for more than 12,000 of the 208,000 SSI disabled recipients in the 6 states GAO examined; (5) over 96 percent of the 158 officials and staff GAO interviewed said they believed that the practice of middlemen helping people improperly qualify for SSI benefits has continued; (6) SSA has taken several actions to reduce the program's vulnerability to this and other forms of fraud; (7) SSA has: (a) established pilot fraud investigation teams in five states during 1998 to examine individual cases where significant fraud and abuse is suspected; (b) developed new policies and procedures to make it easier to deny claims or terminate benefits when program fraud or abuse is detected; and (c) strengthened its ability to handle its non-English speaking clients; (8) these steps have achieved positive results; (9) front-line staff largely rely on their experience and perceptions to identify suspicious claims; they lack other valuable information, such as the names of middlemen and medical providers suspected of fraudulent or abusive practices by other employees or organizations, that could help them judge a claim's validity; (10) SSA and Disability Determination Services (DDS) staff said that they do not always follow the new procedures because they believe the procedures conflict with agency work incentives that stress speed in processing claims and because they believe they are not adequately protected from legal liability that could arise if they were to follow claims denial procedures; (11) they also question the agency's commitment to fighting fraud, since they repeatedly see the same suspicious middlemen and medical providers involved in SSI cases, despite previous referrals for investigation; and (12) several additional types of actions could reduce SSI's vulnerability to fraud and abuse by middlemen and medical providers.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Matter for Congressional Consideration

    Matter: 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.

    Status: Closed - Not Implemented

    Comments: 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

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Not Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Not Implemented

    Comments: 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.

    Recommendation: 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.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: 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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