OFFICE OF
THE INSPECTOR GENERAL

SOCIAL SECURITY ADMINISTRATION

OFFICE OF THE INSPECTOR GENERAL'S
WORK RELATED TO THE
SOCIAL SECURITY ADMINISTRATION'S
BENEFIT PROGRAM AREAS

August 2004

ISSUE PAPER

The Social Security Administration (SSA) pays benefits to (1) Disability Insurance (DI) beneficiaries, (2) Supplemental Security Income (SSI) recipients, and (3) Old-Age and Survivors Insurance (OASI) beneficiaries. As shown in the chart below, the Office of the Inspector General (OIG) focuses its work on all three of these programs-oftentimes focusing on more than one program during a single project. Further, the majority of our work relates to SSA's disability programs-which were placed on the Government Accountability Office's high risk list in January 2004.

As a result of the OIG's work over the last 5 years, we have identified millions of dollars in questioned costs and funds that SSA could put to better use. Further, SSA has agreed with the majority of the recommendations the OIG has made-resulting in actual dollar savings to the Agency.

Fiscal
Year Number of Audit Reports Funds Put to Better Use
(From OIG Semiannual Reports to Congress) Questioned
Costs
(From OIG Semiannual Reports to Congress) Percent of Recommendations Where SSA Agreed
2000 65 $1.3 billion $76.9 million 86%
2001 80 $276.2 million $135.1 million 88%
2002 88 $159.4 million $15.6 million 89%
2003 97 $1.07 billion $56.6 million 90%
2004* 105 $175.9 million $1.75 billion
* Includes actual statistics for October 1, 2003 to August 13, 2004; and estimates for August 14, 2004 to September 30, 2004.

Section II of this report highlights the OIG's work related to SSA's disability programs; whereas section III addresses the SSI program and section IV addresses the OASI program.

A disabled person applies for disability benefits.

SSA assesses the medical and non-medical factors of eligibility.

Individuals meeting the eligibility requirements are placed on the rolls; whereas those who are denied benefits can appeal the decision.

SSA will periodically check to ensure the beneficiary continues to meet the medical and non-medical factors
of eligibility. Any overpayment will be assessed and recovery of the overpaid funds pursued for those no
longer eligible.

SSA will also provide incentives to disabled beneficiaries to assist them in returning to work and getting off the disability rolls.

SSA pays disability benefits under both Titles II and XVI of the Social Security Act. SSA's disability programs provide a continuing income base for eligible workers who have qualifying disabilities and for eligible members of their families before those workers reach retirement age. Table 1 below shows how the OIG has assessed the Agency's disability programs from FY 2000 to the present.

Table 1: Disability Process OIG Work
A person applies for disability under Title II and/or Title XVI. SSA staff assesses the non-medical factors of eligibility; while State Disability Determination Services (DDS) make the medical determination. After the DDS employees review the claim, compile any needed medical evidence, and make a disability determination, they inform SSA of its approval/denial of the application for disability benefits.

The data is entered into SSA's Modernized Claims System (MCS) for Title II disability cases or the Modernized SSI Claims System for SSI disability cases. SSA also uses other electronic systems such as the Master Beneficiary Record (MBR) and Supplemental Security Record. Additionally, SSA maintains a paper folder for each person with key documents in it. (SSA is moving to electronic folders.)
1. The Social Security Administration's Procedures for Presumptive Disability Payments (A-01-98-21005), March 2000

2. Use of Sanctioned Medical Providers by State Disability Determination Services (A-7-99-24006), March 2001

3. Medical Evidence of Record Collection Process at State Disability Determination Services (A-07-99-21003), June 2001

4. Vocational Expert and Medical Expert Fees for Services (A-06-99-51005), August 2001

5. Fees Paid by State Disability Determination Services to Purchase Consultative Examinations (A-07-99-21004), September 2001

6. Assessment of the Electronic Disability Process (A-14-01-11044), October 2001

7. Status of Social Security Administration's Disability Process Improvement Initiatives (A-07-00-10055), June 2002

8. Disability Determination Services' Use of Volume Consultative Examination Providers (A-07-02-12049), March 2003

9. Cooperative Disability Investigation (CDI) Units-consisting of OIG, SSA, DDS, and local law enforcement staff-were established to identify and prevent disability fraud. Since the CDI program's inception in 1998, 18 units have been set up in 17 States

10. Disability Determination Services' Claims Processing Performance (A-07-03-13054), expect to issue by September 2004

11. Best Practices in Highest Producing Hearing Offices (A-12-04-14020), expect to issue by September 2004

12. Individuals Receiving Benefits Under Multiple Social Security Numbers at the Same Address (A-01-05-25002), expect to issue in FY 2005

If a DDS denies a claim, the DDS issues a denial notice to the applicant and inputs the decision to the Information Network System. No further SSA field office action is required unless the applicant disagrees with the denial.

In the case of a disagreement, the applicant has 60 days to appeal and request reconsideration. If the result of the reconsideration is unfavorable, the applicant may, within 60 days, request a hearing with an administrative law judge (ALJ) of SSA's Office of Hearings and Appeals (OHA). If the applicant disagrees with the ALJ's decision, (s)he may, within 60 days, request a review by the Appeals Council. A Civil Action in a Federal District Court may be filed within 60 days of the Appeals Council's decision if the applicant disagrees.

If at any point during this appeal process the denial decision is overturned, the application is processed and the applicant will begin receiving benefits.

1. Controls Over Administrative Law Judges' Decisions (limited distribution)(A-06-00-10026), September 2000

2. Assessment of the Hearings Process Improvement Plan Phase I (A-06-00-20051), June 2001

3. Internal Controls Over the Office of Hearings and Appeals Interpreter Services (A-12-00-10023), August 2001

4. Appeals Council Process Improvement Action Plan (A 12 02-12015), January 2004

5. Operations of the Office of Hearings and Appeals Megasite (A-12-03-13039), February 2004

6. The Effects of Staffing on Hearing Office Performance-plan to issue report in FY 2005

7. OHA Reversal of Disability Denial Decisions Involving Investigative Information from Cooperative Disability Investigative Units-plan to initiate review in FY 2005

8. SSA's Processes for Discontinuing SSI Payments Following Disability Cessation-plan to initiate review in FY 2005

Once a person starts receiving disability benefits, SSA will periodically conduct a continuing disability review (CDR) to determine if the person is still eligible for benefits. If medical improvement occurs and/or the beneficiary no longer meets the medical or non-medical eligibility factors, benefits will be stopped. Benefits may also be stopped for non-medical reasons-such as imprisonment, death, etc. Additionally, SSA will assess an overpayment, if appropriate, and initiate recovery of the overpaid funds. The person can also request a waiver of the overpayment and SSA may write the overpayment off as uncollectible.

1. Workers' Compensation Unreported by Social Security Beneficiaries (A-04-98-64002), December 1999

2. Reliability of Diagnosis Codes Contained in the Social Security Administration's Data Bases (A-01-99-61001), March 2000

3. Implementation of Drug Addiction and Alcoholism Provisions of Public Law 104-121 (A-01-98-61014), May 2000

4. Improving the Usefulness of the Social Security Administration's Death Master File (A-09-98-61011), July 2000

5. Status of the Social Security Administration's Updates to the Medical Listings (A-01-99-21009), August 2000

6. OASDI Benefits Paid to Deceased Auxiliary Beneficiaries (A-01-00-20043), June 2001

7. Unresolved Death Alerts Over 120 Days Old (A-09-00-10001), August 2001

8. Follow-up Review of SSA's Implementation of Drug Addiction and Alcoholism Provisions of Public Law 104 121
(A-01-01-11029), December 2001

9. Controls Over the Social Security Administration's Processing of Death Records from the Department of Veterans Affairs
(A-01-01-21038), February 2002

10. Continuing Disability Reviews for Supplemental Security Income Recipients Approved Based on Low Birth Weight
(A-01-02-12031), June 2002

11. Effectiveness of the Social Security Administration's Death Termination Process (A-09-02-22023), September 2002

12. OASDI and SSI Payments to Deceased Beneficiaries and Recipients (A-06-02-12012), October 2002

13. Congressional Response Report: SSA's Efforts to Process Death Reports and Improve its Death Master File
(A-09-03-23067), January 2003

14. Management Advisory Report: SSA's Workers' Compensation Match with the State of Texas (A-06-03-13022), April 2003

15. Pending Workers' Compensation: SSA Can Prevent Millions in Title II Disability Overpayments (A-08-02-12064), June 2003

16. Follow-up Review of OASDI Benefits Paid to Deceased Auxiliary Beneficiaries (A-01-03-13037), June 2003

17. Data Matching with Foreign Countries (A-13-03-23015), June 2003

18. Follow-up on Prior Office of the Inspector General Prisoner Audits (A-01-02-12018), July 2003

19. Management Advisory Report: Title II Disability Insurance Benefits with Workers' Compensation Underpayment Errors Exceeding $70,000 (A-04-02-21054), July 2003

20. Issue Paper: Detecting, Preventing, and Eliminating Unidentified Overpayments in the Social Security Administration's Disability Programs (Limited Distribution) (A-09-02-22067), September 2003

21. Disabled Title II Beneficiaries with Earnings Reported on the Master Earnings File (A-01-03-13019), July 2004

22. Civil Monetary Penalty Program allows OIG to impose penalties against violators of section 1129 (false statements) of the Social Security Act

23. Individuals Receiving Multiple Childhood Disability Benefits (A-01-04-24078), expect to issue report by September 2004|

24. Overpayments in the Old-Age, Survivors and Disability Insurance Program (A-01-04-24023), expect to issue by September 2004

25. Disabled SSI Recipients with Earnings (A-01-04-14085), expect to issue report in FY 2005

26. Undetected Overpayments in SSA's Disability Programs (A-01-04-24065), expect to issue report in FY 2005

27. SSA's Rules of Administrative Finality (A-01-04-24024), expect to issue in FY 2005

28. SSA's Clean-Up of Title II Disability Insurance Cases with a Workers' Compensation Offset (A-04-03-13042), expect to issue in FY 2005

29. Review of SSA's Workers' Compensation Data Match with the State of Texas-plan to initiate review in FY 2005

30. Controls Over Old-Age, Survivors and Disability Insurance Replacement Checks-plan to initiate review in FY 2005

31. Waivers Granted for OASDI Overpayments-plan to initiate review in FY 2005

SSA has assorted programs to assist disabled beneficiaries return to work (e.g., ticket to work, impairment-related work expenses, trial work period, etc.)

1. Beneficiaries Expressing Interest in Vocational Rehabilitation Services Through a Continuing Disability Review Mailer (A-01-97-61004), November 1999

2. The Social Security Administration's Controls over Impairment-Related Work Expense Income Exclusions (A-01-98-61010), December 1999

3. Review of SSA's Ticket to Work Program (A-02-03-13079), expect to issue in FY 2005

4. SSA's Ticket to Work Program: Assignment of Tickets-plan to initiate in FY 2005

Needy individual comes to SSA to apply for SSI benefits.

SSA staff determines whether the person qualifies for SSI.

SSI is paid to those who qualify based on income, resources, living arrangements, etc.

SSA will periodically check to ensure the person continues to remain eligible for benefits. Any overpayment will be assessed and recovery of the funds pursued for those who no longer qualify.

The SSI program-authorized by Title XVI of the Social Security Act-provides or supplements the income of aged, blind, or disabled individuals with limited income and resources. Table 2 below shows how the OIG has assessed the SSI program from FY 2000 to the present.

Table 2: SSI Process OIG Work
A person files a claim for SSI payments. SSA staff obtain from the claimant the necessary information (name, SSN, living arrangements, resources, income, potential eligibility for other benefits, etc.) to evaluate the application and determine whether the person is eligible for SSI payments. The data is entered into Modernized SSI Claims System and posted to the Supplemental Security Income Record. Additionally, SSA maintains a paper folder for each claimant/recipient with key documents in it. (SSA is moving to electronic folders.)

1. Management Advisory Report: Best Practices in Federal Paper Records Management (A-04-03-13030), June 2003

2. Audit of the Wilkes-Barre Folder Serving Operation (A-04-03-13040), September 2003

3. Individuals Receiving Benefits Under Multiple Social Security Numbers at the Same Address (A-01-05-25002), expect to issue in FY 2005

If SSA determines the person is eligible for SSI, payments will begin.
If SSA determines the person is not eligible, the person can appeal the decision. If the person wins the appeal, he/she will start collecting SSI payments.

1. Deeming of Income to Establish Initial Eligibility for Supplemental Security Income Recipients (A-05-99-21005), September 2001

2. Review of Internal Controls for the Supplemental Security Income Immediate Payment Process (A-05-00-10045), September 2002

3. Controls Over Supplemental Security Income Replacement Checks (A-05-03-13010), September 2003

Once individuals start collecting SSI payments, SSA continues to evaluate whether they remain eligible for monthly payments. SSA relies on SSI recipients (or their representative payees) to report events to the Agency that could impact eligibility or payment amount. SSA also conducts redeterminations, which consist of reviewing the non-medical information to determine if the SSI recipient is still eligible for payments. Additionally, SSA obtains and matches data from a variety of sources to identify factors that may make a recipient ineligible for SSI payments. Some of the events that may occur after an SSI recipient is placed on the rolls that could affect eligibility include:

1. Death.

2. Marriage.

3. Turning certain ages, such as age 18.

4. Change in living arrangements.

5. Becoming a prisoner, fugitive felon, or parole/probation violator.

6. Earning income or resources in excess of allowable amounts under the SSI program.

7. Living outside the United States for more than 30 days. 1. Improving the Usefulness of the Social Security Administration's Death Master File (A-09-98-61011), July 2000

2. Identification of Fugitives Receiving Supplemental Security Income Payments (A-01-98-61013), August 2000

3. Review of Controls Over Processing Income Alerts Which Impact Supplemental Security Income Payments
(A-05-98-21002), September 2000

4. Redeterminations for Supplemental Security Income Recipients Attaining Age 18 (A-01-00-10013), December 2000

5. Effectiveness of the Social Security Administration's Special Project Reviews of Supplemental Security Income Recipients (A-09-99-62010), May 2001

6. Unresolved Death Alerts Over 120 Days Old (A-09-00-10001), August 2001

7. Establishing Living Arrangements and Value of In-Kind Support and Maintenance for Supplemental Security Income Recipients ((A-05-99-21002), September 2001

8. Controls Over the Social Security Administration's Processing of Death Records from the Department of Veterans Affairs
(A-01-01-21038), February 2002

9. Congressional Response Report: Integrity of the Supplemental Security Income Program (A-01-02-22095), August 2002

10. Effectiveness of the Social Security Administration's Death Termination Process (A-09-02-22023), September 2002

11. Controls to Prevent Supplemental Security Income Payments to Recipients Living in Foreign Countries (A-01-02-12013), September 2002

12. OASDI and SSI Payments to Deceased Beneficiaries and Recipients (A-06-02-12012), October 2002

13. Congressional Response Report: SSA's Efforts to Process Death Reports and Improve its Death Master File
(A-09-03-23067), January 2003

14. Follow-up on Prior Office of the Inspector General Prisoner Audits (A-01-02-12018), July 2003

15. Assessment of the Supplemental Security Income Fugitive Felon Project (A-01-03-23070), September 2003

16. Effectiveness of SSA's Controls and Procedures over SSI Death Alerts-plan to initiate review in FY 2005

17. Supplemental Security Income Recipient Wages Reported to the Earnings Suspense File-plan to initiate review in FY 2005
If SSA determines that an SSI recipient is no longer eligible, the Agency will stop the payments; and, if necessary, assess an overpayment for payments that should not have been issued.

SSA notifies the person of the suspension and/or overpayment. The Agency will then attempt to resolve the overpayment-including recovering the overpaid funds, waiving the overpayment, or writing the overpayment off as uncollectible.

1. Controls Over Recording Supplemental Security Income Overpayments (A-01-00-10005), May 2001

2. Management Advisory Report: Social Security Administration Employees with Title XVI Overpayment Write-offs
(A-04-99-64005), September 2002

3. Supplemental Security Income Overpayments (A-01-04-24022), April 2004

4. Civil Monetary Penalty Program allows OIG to impose penalties against violators of section 1129 (false statements) of the Social Security Act

5. SSA's Controls Over Suspending Collection Efforts on Title XVI Overpayments (A-04-04-24029), expect to issue in FY 2005

6. SSA's Controls Over the Title XVI Overpayment Waiver Process (A-06-03-13077), expect to issue in FY 2005

7. SSA's Rules of Administrative Finality (A-01-04-24024), expect to issue in FY 2005

8. Uncollectible Title XVI Overpayments-plan to initiate review in FY 2005

Individuals apply for retirement or survivors benefits.

SSA assesses application to determine if applicant qualifies for benefits.

If applicant meets SSA requirements, benefits are paid.

SSA will periodically check to ensure the person continues to remain eligible for benefits. Any overpayment will be assessed and recovery of the funds pursued for those who no longer qualify for benefits.

SSA's OASI program provides retired workers with supplemental retirement income; and benefits to qualified members of retired workers' families-such as surviving spouses and dependent children. Table 3 below shows how the OIG has assessed the Agency's OASI program from FY 2000 to the present.

Table 3: OASI Process OIG Work
A person files an application for Old-Age or Survivors benefits-or SSA converts a beneficiary from another program to OASI upon meeting the eligibility criteria (such as attaining retirement age). SSA staff evaluates the application and determines whether the person is eligible for benefits.
The data is entered into SSA's Modernized Claims System (MCS) and is posted to the MBR. Additionally, SSA maintains a paper folder for each claimant/beneficiary with key documents in it. (SSA is moving to electronic folders.)

1. Conversion of Benefits for Spouses After the Death of a Wage Earner (A-09-99-62009), September 2000

2. Case Folder Storage and Retrieval at the Social Security Administration's Megasite Records Center (A 04 99 62006), August 2002

3. Inventory Review at the National Records Center (A 07 04-24026), February 2004

4. Individuals Receiving Benefits Under Multiple Social Security Numbers at the Same Address (A-01-05-25002), expect to issue in FY 2005

Once individuals start collecting OASI benefits, SSA continues to evaluate whether they remain eligible for monthly payments. SSA relies on beneficiaries (or their representative payees) to report events to the Agency that could impact eligibility or payment amount. Additionally, SSA obtains and matches data from a variety of sources to identify factors that may make a beneficiary ineligible for OASI benefits. Some of the events that may occur after an OASI beneficiary is placed on the rolls that could affect eligibility include death, marriage, becoming a prisoner, etc.

If SSA determines that a beneficiary is no longer eligible for OASI benefits, payments will stop and, if appropriate, an overpayment will be assessed. SSA will then attempt to resolve the overpayment through recovery of the funds, waiving the overpayment, or writing it off as uncollectible.

1. Payments to Child Beneficiaries Age 18 or Over Who Were Neither Students Nor Disabled (A-09-99-63008), May 2000

2. Improving the Usefulness of the Social Security Administration's Death Master File (A-09-98-61011), July 2000

3. Payments to Young Spouses and Surviving Spouses Without Child In-Care (A-09-00-10002), March 2001

4. OASDI Benefits Paid to Deceased Auxiliary Beneficiaries (A-01-00-20043), June 2001

5. Unresolved Death Alerts Over 120 Days Old (A-09-00-10001), August 2001

6. OIG BIC D Project-initiated in FY 2001-to identify widows who were deceased but receiving benefits

7. Controls Over the Social Security Administration's Processing of Death Records from the Department of Veterans Affairs
(A-01-01-21038), February 2002

8. The Social Security Administration Can Recover Millions in Medicare Premiums Related to Retirement or Disability Payments Made after Death (A-08-02-12029), July 2002

9. Effectiveness of the Social Security Administration's Death Termination Process (A-09-02-22023), September 2002

10. Impact on the Social Security Administration's Programs When Auxiliary Beneficiaries Do Not Have Their Own Social Security Numbers (A-01-02-22006), September 2002

11. Medicare Non-Usage Project in FY 2002 identified fraud cases related to unreported deaths

12. OASDI and SSI Payments to Deceased Beneficiaries and Recipients (A-06-02-12012), October 2002

13. Follow-up Review of OASDI Benefits Paid to Deceased Auxiliary Beneficiaries (A-01-03-13037), June 2003

14. Use of State Bureaus of Vital Statistics Records to Detect Unreported Marriages and Divorces (A-09-00-30059), June 2003

15. Data Matching with Foreign Countries (A-13-03-23015), June 2003

16. Follow-up on Prior Office of the Inspector General Prisoner Audits (A-01-02-12018), July 2003

17. Impact on the Social Security Administration's Programs When Auxiliary Beneficiaries Have Incorrect Social Security Numbers (A-01-03-33020), November 2003

18. Social Security Administration Controls over the Taxation and Suspension of Payments to Foreign Beneficiaries
(A 14-03-23005), March 2004

19. Payments to Student Beneficiaries Beyond the Maximum Age of Entitlement (A-09-04-14050), August 2004

20. Overpayments in the Old-Age, Survivors and Disability Insurance Program (A-01-04-24023), August 2004

21. Civil Monetary Penalty Program allows OIG to impose penalties against violators of section 1129 (false statements) of the Social Security Act

22. Individuals Receiving Multiple Auxiliary or Survivor Benefits (A-01-05-25015), expect to issue in FY 2005

23. Follow-up of School Attendance by Student Beneficiaries Over Age 18 (A-09-04-14013), expect to issue in FY 2005

24. SSA's Rules of Administrative Finality (A-01-04-24024), expect to issue in FY 2005

25. SSA's Controls Over OASDI Overpayments That Were Suspended or Written Off As Uncollectible-plan to initiate review in FY 2005

26. Waivers Granted for OASDI Overpayments-plan to initiate review in FY 2005

27. Controls Over Old-Age, Survivors and Disability Insurance Replacement Checks-plan to initiate review in FY 2005