Controls Over Medical Examinations Necessary for the Social Security Administration To Better Determine Disability

HRD-79-119: Published: Oct 9, 1979. Publicly Released: Oct 9, 1979.

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In 1978 the federal disability insurance program and the Supplemental Security Insurance program paid about $72 million for independent medical examinations of persons claiming disability. The need for and the quality of the medical information purchased is not well documented. Program officials do not know how often state agencies have paid for independent medical examinations which were too comprehensive or were inadequate for determining disability without further information. The way disability decisions are reached differs considerably among the 54 state agencies under contract with the Department of Health, Education, and Welfare (HEW). Social Security Administration (SSA) budget officials have attempted to control the increase in the number of examinations by limiting budget increases until program officials could justify them. Two of the most important factors in determining what the consultative examination purchase rate should be and the number of examinations being purchased unnecessarily are program documentation standards and state agency case development practices.

Differences within SSA over the consultative examination budget demonstrates the need for an improved measurement system. Since SSA does not accurately measure state agency performance and evaluate key issues affecting consultative examination purchases, the appropriate spending level for examinations has not been determined. There is little reliable information on the quality of the medical information purchased. The objective of the disability determination process is to provide quality, uniform decisions to claimants in the least possible time and at the lowest cost to the government. These standards of quality, timeliness, and cost can help to identify problems. However, SSA emphasizes these standards separately and uses them individually to measure performance. This practice encourages state agencies to adopt expedients to meet the short-term goal at the expense of the other goals and the overall program objective.

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  • employment icon, source: GAO

    Priority Open Recommendations:

    Department of Labor
    GAO-19-395SP: Published: Apr 3, 2019. Publicly Released: Apr 10, 2019.

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