Supplemental Security Income Quality Assurance System:

An Assessment of Its Problems and Potential for Reducing Erroneous Payments

HRD-77-126: Published: May 23, 1978. Publicly Released: May 23, 1978.

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The Social Security Administration (SSA) established a quality assurance system in 1974 to provide information on how well its Supplemental Security Income (SSI) program is operating. Through this system, data were collected which indicated that, at the end of 1976, over $1.4 billion had been overpaid and $277 underpaid to recipients in the program. The system also provides data for determining the liability of the federal government to states for incorrect state supplemental payments which are administered by SSA.

A sampling of 556 quality assurance cases showed 3.4 percent more cases with errors than were shown by the quality assurance system. Also, quality assurance made incorrect determinations on 32 of the 150 deficiencies it identified. Weaknesses which affected the system's reliability were: (1) failure to follow procedures; (2) an improperly structured form for documenting case findings; (3) lack of review of case files; and (4) inadequate personnel training. Error rate statistics are understated because SSA excludes cases from sampling which may bias findings and does not report certain errors. Resources used to obtain data on state supplements reduce quality assurance resources that could be used for corrective action analyses. The system's database does not provide sufficient data for corrective action recommendations, and SSA does not have a formal corrective action system. Three other program evaluation groups within SSA with responsibility for evaluating the SSI program have redundant functions and lack coordination.

Recommendation for Executive Action

  1. Status: Closed

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

    Recommendation: The Secretary of Health, Education, and Welfare should direct the Commissioner, SSA, to improve the uniformity, accuracy, and reliability of the quality assurance system's review process and data by: (1) adopting a revised form to obtain, during the review process, all pertinent eligibility and payment data; assessing its case review policy and considering review of all sample cases and resolving problems of obtaining files through the SSI claims control system; (2) establishing an adequate training program; (3) assessing exclusion policies in sampling; and (4) reporting all errors found during review. He should also direct the Commissioner to: (1) concentrate more resources on correcting specific problems by studying the feasibility of using some other mechanism for determining the federal government's liability to states; (2) directing more resources to gather data on types and causes for errors, and (3) establishing a formal corrective action system; and assess the need for four SSA groups to evaluate the SSI program.

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