Pursuant to a congressional request, GAO reviewed overpayments to Supplemental Security Income (SSI) recipients in nursing homes and other medical treatment institutions, focusing on: (1) the extent of such overpayments; (2) the success or failure of the Social Security Administration's (SSA) actions in preventing and detecting these overpayments; and (3) the methods by which SSA can better prevent such overpayments.
Recommendations for Executive Action
|Department of Health and Human Services||To prevent overpayments to SSI recipients in nursing homes or detect them sooner, the Secretary of Health and Human Services should direct the Administrator of the Health Care Financing Administration (HCFA) to require states, as part of Medicaid management information systems (MMIS) systems requirements, to include information on nursing home admissions as standard data elements in their MMIS and make these data elements available to SSA electronically, in accordance with the laws and standards governing computer matching, privacy, and security.|
|Social Security Administration||The Commissioner of Social Security should establish agreements with the states to routinely obtain state MMIS data on nursing home admissions electronically as soon as feasible.|
|Social Security Administration||The Commissioner of Social Security should establish interim agreements with state Medicaid agencies, while states adapt their systems to make this information available to SSA electronically, to obtain computer tapes or paper listings of admissions to nursing homes and use this information to identify overpayment situations and begin recovery actions and payment reductions.|
|Social Security Administration||The Commissioner of Social Security should determine the reliability of state MMIS data for purposes of supporting automatic benefit reductions for those SSI recipients identified as residing in nursing homes for a full month who are not eligible for continuation of full benefits due to temporary institutionalization and, if the data are reliable, implement a system for automatic benefit reduction.|