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    Subject Term: "Disability programs"

    6 publications with a total of 15 open recommendations including 2 priority recommendations
    Director: Seto Bagdoyan
    Phone: (202) 512-6722

    4 open recommendations
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to lead a comprehensive fraud risk assessment that is consistent with leading practices, and develop a plan for regularly updating the assessment.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to develop, document, and implement an antifraud strategy that is aligned to its assessed fraud risks.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to work with components responsible for implementing antifraud initiatives to develop outcome-oriented metrics, including baselines and goals, where appropriate for antifraud activities.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Recommendation: The Commissioner (or Acting Commissioner) of SSA should direct the OAFP to review progress toward meeting goals on a regular basis, and recommend that the NAFC make changes to control activities or take other corrective actions on any initiatives that are not meeting goals.

    Agency: Social Security Administration
    Status: Open

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    4 open recommendations
    Recommendation: To ensure that it provides all eligible populations access to its services and that its eligibility requirements are consistent with currently accepted practices, the Library of Congress should re-examine and potentially revise its requirement that medical doctors must certify eligibility for the NLS program for those with a reading disability caused by organic dysfunction.

    Agency: Library of Congress
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has contracted for a study of how eligibility based on reading disability should be certified. This study will look at medical advances in the diagnosis of reading disabilities, the NLS authorizing statute, and the potential impact of a regulatory change on the program. The expected completion date is December 2017. To close this recommendation, the Library of Congress must demonstrate that this study has been completed and that NLS has determined whether a change in its requirements is warranted.
    Recommendation: To ensure funds are directed to the most cost-effective outreach efforts, NLS should evaluate the effectiveness of its outreach efforts, including the extent to which different outreach efforts have resulted in new users.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has begun revising the program application form so that it captures information on how applicants were referred to the program. NLS expects to have all libraries nationwide using this revised application by sometime in 2018. In addition, the Library of Congress indicated that NLS has contracted for a multi-year, multi-media advertising campaign. This effort will assess the effectiveness of different approaches by connecting direct responses to ads with verified program enrollment. The campaign is expected to be fully underway by January 2018. To close this recommendation, the Library of Congress will need to demonstrate that NLS has fully implemented one or more of its planned new approaches for evaluating outreach.
    Recommendation: To help it determine the most cost-effective approach for its next audio player, NLS should comprehensively assess the alternatives of designing its own specialized audio player versus providing commercially available players to its users.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has contracted for a study of the different commercially available audio players for their usability, life-cycle costs, maintenance needs, and durability. The study is expected to be completed by December 2017, and will guide NLS in its decision about how to develop its next generation of audio players. To close this recommendation as implemented, the Library of Congress will have to demonstrate that this study has been conducted and that NLS has considered its findings in making a decision about its next generation audio player.
    Recommendation: To help it determine whether to supplement its collection of human-narrated audio materials with text-to-speech materials, NLS should thoroughly assess the text-to-speech option versus continuing to provide only human-narrated materials.

    Agency: Library of Congress: National Library Service for the Blind and Physically Handicapped
    Status: Open

    Comments: The Library of Congress indicated that the National Library Service for the Blind and Physically Handicapped (NLS) has developed a library of 100 text-to-speech (synthetic speech) talking books. In September 2017, NLS will begin a 3-month pilot in which a group of NLS users try out these talking books and provide input to NLS. Also, NLS will require that its next generation of audio players have the capacity to play synthetic speech talking books, and the study it has contracted of commercially available players will consider this requirement among other factors. To close this recommendation as implemented, NLS needs to demonstrate that it has completed its text-to-speech pilot and has decided on an approach going forward with regards to expanding this program.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    2 open recommendations
    Recommendation: As part of initiatives currently under way to improve agency information on claims with appointed representatives and detect potential fraud associated with representatives, the Commissioner of the Social Security Administration should consider actions to provide more timely access to data on representatives and enhance mechanisms for identifying and monitoring trends and patterns related to representation, particularly trends that may present risks to program integrity. Specifically, SSA could (1) Identify additional data elements, or amendments to current data collection efforts, to improve information on all appointed representatives, including those under contract with states and other third parties; (2) Implement necessary policy changes to ensure these data are collected. This could include enhancing technical systems needed to finalize SSA's 2008 proposed rules that would recognize organizations as representatives; and (3) Establish mechanisms for routine data extracts and reports on claims with representatives.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2017, SSA reported that it is approaching the conclusion of the first phase of a new initiative, called Registration, Appointment and Services for Representatives (RASR). This initiative aims to register all appointed representatives and improve relevant business processes and data collection. SSA reported that it had to postpone the first release of RASR, originally targeted for December 2016, due to some systems issues. SSA stated that it has not yet set a new target date for the first release. SSA stated that this new application will enhance data collection and management of representatives' information and that it will help make strides toward better oversight and improved data analysis and reporting. We will consider closing this recommendation when these efforts are completed.
    Recommendation: To address risks associated with potential overpayments to representatives and protect claimant benefits, the Commissioner of the Social Security Administration should take steps to enhance coordination with states, counties, and other third parties with the goal of improving oversight and preventing and identifying potential overpayments. This coordination could be conducted in a cost-effective manner, such as issuing guidance to states and other third parties on vulnerabilities for overpayment; sharing best practices on how to prevent overpayments; or considering the costs and benefits, including any privacy and security concerns, of providing third parties controlled access to portions of the eFolder to facilitate the detection of potential overpayments.

    Agency: Social Security Administration
    Status: Open

    Comments: In July 2017, SSA stated that it added a section to a new form--Form SSA-1698, Fee Agreement for Representation before the Social Security Administration--that claimants and representatives can use to enter into fee agreements. According to SSA, this form requires the disclosure of fees that the representative will receive from a third party and the amount of those fees. SSA expects this form to be in use upon OMB approval. Similar language already exists in another form--Form SSA-1560-U4, Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration--that claimants and representatives can use for fee petitions. SSA stated that these forms are (and will be) included in the folder of evidence that adjudicators may review before determining whether and how much to authorize in fees. According to SSA, disclosure and approval of any third party fees, with potential adjustment of the fee, by both the claimant and SSA should help prevent excessive fees. While the proposed change to the form may help improve transparency of fee arrangements, the potential for a representative to receive a payment from SSA and also receive a payment from a state or other third party still exists. Unless SSA and the state or other third party share information on their payments or have policies and procedures in place to prevent such cases, representatives could still receive both SSA and state payments that total more than the SSA-authorized fee. In order to address this vulnerability, we continue to believe that SSA should enhance coordination or issue guidance to states and other third parties about this vulnerability, which could include SSA sharing best practices for preventing these types of overpayments. For example, one state requires contracted organizations to submit copies of their signed form 1696 (Appointment of Representative) so the state could verify the representative checked the appropriate box for payment.
    Director: Daniel Bertoni
    Phone: (202) 512-7215

    3 open recommendations
    including 1 priority recommendation
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to address potential disincentives for staff to detect and prevent physician-assisted fraud, SSA should review the standards used to assess DDS performance; and develop and distribute promising practices to incentivize staff to better balance the goal of processing claims promptly with the equally important goal of identifying and reporting evidence of potential fraud.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA partially agreed with this recommendation, citing that their employees take their stewardship responsibilities seriously and that field office and disability determination services (DDS) employees are the agency's first and best line of defense against fraud. In 2016, the agency reported that it was working with experts in its OIG and Office of Anti-Fraud Programs to develop and disseminate promising practices on identifying and reporting fraud. We will close this recommendation once SSA takes steps to review its standards for assessing DDS performance and disseminates the best practices it is developing.
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to address the potential risks associated with medical evidence submitted by sanctioned physicians, SSA should evaluate the threat posed by this information and, if warranted, consider changes to its policies and procedures.

    Agency: Social Security Administration
    Status: Open

    Comments: As of 2016, SSA reported that it was pursuing several options to address the potential risks of medical evidence submitted by sanctioned physicians. This included determining how it could use licensure information from the List of Excluded Individuals and Entities. SSA stated that it believes the best opportunity to further evaluate the possible review of the license statuses of medical evidence providers is in conjunction with the implementation of the National Vendor File, part of the national Disability Case Processing System, which is under development. In addition, SSA reported it had drafted two Social Security Rulings to define fraud and to provide processes for disregarding evidence and making redeterminations in disability claims when there is reason to believe that fraudulent evidence was provided. We will close this recommendation once SSA articulates a strategy for using license status information in the vendor file and it finalizes its rulings.
    Recommendation: To improve the ability of the agency to detect and prevent potential physician-assisted fraud, and to help ensure new initiatives that use analytics to identify potential fraud schemes are successful, SSA should develop an implementation plan that identifies both short- and long-term actions, including: (1) timeframes for implementation; (2) resources and staffing needs; (3) data requirements, e.g., the collection of unique medical provider information; (4) how technology improvement will be integrated into existing technology improvements such as the Disability Case Processing System and National Vendor File; and (5) how different initiatives will interact and support each other.

    Agency: Social Security Administration
    Status: Open
    Priority recommendation

    Comments: Since fiscal year 2015, SSA has taken several steps that will help the agency to combat fraud, waste, and abuse. SSA established the Office of Anti-Fraud Programs to provide centralized oversight and accountability for the agency's initiatives, which, in consultation with the Office of the Inspector General and other SSA components, will lead the development of SSA's anti-fraud initiatives and activities. This includes efforts to mitigate fraud through data analytics that utilize SSA's existing data systems. SSA developed a strategic plan for fiscal years 2016-2018 to guide its anti-fraud efforts that includes the use of data analytics. However, this plan does not specifically address actions to combat potential physician-assisted fraud. As of April 2017, SSA stated that it continued to develop a fraud management strategy that is consistent with the leading practices identified in GAO's report. Once the strategy is complete, SSA plans to conduct a fraud risk assessment on its major lines of business, beginning with the disability program in fiscal year 2017. We will continue to monitor SSA's progress to identify and prevent fraud schemes that include physicians.
    Director: Bertoni, Daniel
    Phone: (202)512-5988

    1 open recommendations
    Recommendation: The incoming Commissioner of Social Security should determine if realigning the agency's headquarters, regional, or field office structure could yield increases in the agency's effectiveness and efficiency by launching an exploratory effort to assess the utility and feasibility of such a realignment or consolidation. These efforts could include holding discussions with other federal agencies, such as the Census Bureau and the Internal Revenue Service, to learn about their experiences undergoing similar transformations and studying the likely costs and benefits of consolidation, as well as other potential impacts.

    Agency: Social Security Administration
    Status: Open

    Comments: SSA has determined that it will realign its office structure to support expanded online service delivery, but the agency has not yet taken steps to fully assess the utility and feasibility of such a realignment, such as studying the likely costs, benefits, and other potential impacts. In its March 2014 Agency Strategic Plan for Fiscal Years 2014-2018, SSA stated its intent to expand online services and encourage customers to conduct business with SSA online and said that the agency will streamline its field office structure, as well as its administrative office structure, to reduce costs and make the best use of its employees' time and skills. SSA also consulted with other federal agencies to learn about their experiences with similar efforts. In its April 2015 Vision 2025 document, SSA stated that the agency will align its physical infrastructure to efficiently meet customer and business needs. However, SSA needs to take additional concrete steps, such as defining specific actions the agency will need to take and resources required to achieve this vision.
    Director: Bertoni, Daniel
    Phone: (202) 512-7215

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To help ensure that SSA's disability decisions are as equitable and consistent with modern views of disability as possible, the Commissioner of Social Security should conduct limited and focused studies on the availability and effects of considering more fully assistive devices and workplace accommodations in its disability determinations.

    Agency: Social Security Administration
    Status: Open
    Priority recommendation

    Comments: On September 30, 2015 a committee convened by the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine initiated a study on assistive technology and workplace accommodations. As of April, 2017, SSA reported that the committee held public sessions on May 16, 2016, July 18, 2016, and September 27, 2016 at which several experts presented on relevant topics. The committee will use the information from these presentations along with their own research and literature to review and provide findings and conclusions for their final report which is expected by July 31, 2017. In April 2017, SSA also indicated it has collected additional information on consideration of reasonable accommodations through the Idea Scale system--a crowd sourcing technology. Depending on the results of the HMD study, SSA may potentially collect additional information on work accommodations through the Bureau of Labor Statistics' OIS project. We will continue to monitor the status and results of the HMD analysis and SSA's actions based on the committee's results and recommendations.