SOCIAL SECURITY ADMINISTRATION

ADMINISTRATIVE COSTS CLAIMED
BY THE CALIFORNIA DISABILITY
DETERMINATION SERVICES

July 2007

A-09-06-16129

AUDIT REPORT

Mission

By conducting independent and objective audits, evaluations and investigations, we inspire public confidence in the integrity and security of SSA's programs and operations and protect them against fraud, waste and abuse. We provide timely, useful and reliable information and advice to Administration officials, Congress and the public.

Authority

The Inspector General Act created independent audit and investigative units, called the Office of Inspector General (OIG). The mission of the OIG, as spelled out in the Act, is to:

Conduct and supervise independent and objective audits and investigations relating to agency programs and operations.
Promote economy, effectiveness, and efficiency within the agency.
Prevent and detect fraud, waste, and abuse in agency programs and operations.
Review and make recommendations regarding existing and proposed legislation and regulations relating to agency programs and operations.
Keep the agency head and the Congress fully and currently informed of problems in agency programs and operations.

To ensure objectivity, the IG Act empowers the IG with:

Independence to determine what reviews to perform.
Access to all information necessary for the reviews.
Authority to publish findings and recommendations based on the reviews.

Vision

We strive for continual improvement in SSA's programs, operations and management by proactively seeking new ways to prevent and deter fraud, waste and abuse. We commit to integrity and excellence by supporting an environment that provides a valuable public service while encouraging employee development and retention and fostering diversity and innovation.

MEMORANDUM

Date: July 31, 2007

To: Peter D. Spencer
Regional Commissioner San Francisco

From: Inspector General

Subject: Administrative Costs Claimed by the California Disability Determination Services (A-09-06-16129)

OBJECTIVE

The objectives of our audit of the California Disability Determination Services (CA DDS) were to (1) evaluate internal controls over the accounting and reporting of administrative costs, (2) determine whether costs claimed were allowable and funds were properly drawn, and (3) assess limited areas of the general security controls environment.

BACKGROUND

The Disability Insurance program, established under Title II of the Social Security Act (Act), provides benefits to wage earners and their families in the event the wage earner becomes disabled. The Supplemental Security Income program, established under Title XVI of the Act, provides benefits to financially needy individuals who are aged, blind, or disabled.

The Social Security Administration (SSA) is responsible for implementing policies for the development of disability claims under the Disability Insurance and Supplemental Security Income programs. Disability determinations under both Disability Insurance and Supplemental Security Income are performed by disability determination services (DDS) in each State or other responsible jurisdiction in accordance with Federal regulations. In carrying out its obligation, each DDS is responsible for determining claimants' disabilities and ensuring adequate evidence is available to support its determinations. To assist in making proper disability determinations, each DDS is authorized to purchase medical examinations, x rays, and laboratory tests on a consultative basis to supplement evidence obtained from the claimants' physicians or other treating sources.

SSA reimburses the DDS for 100 percent of allowable expenditures up to its approved funding authorization. The DDS withdraws Federal funds through the Department of the Treasury's Automated Standard Application for Payment system to pay for program expenditures. Funds drawn down must comply with Federal regulations and intergovernmental agreements entered into by the Department of the Treasury and States under the Cash Management Improvement Act of 1990. An advance or reimbursement for costs under the program must comply with Office of Management and Budget Circular A 87, Cost Principles for State, Local, and Indian Tribal Governments. At the end of each quarter of the FY, each DDS submits a Form SSA 4513, State Agency Report of Obligations for SSA Disability Programs, to account for program disbursements and unliquidated obligations.

CA DDS is a component of the California Department of Social Services (DSS), Disability and Adult Programs Division. For Fiscal Years (FY) 2004 and 2005, CA DDS had about 1,500 employees and an authorized budget of $387 million for administrative costs. As of September 30, 2005, DSS reported total disbursements of $375.7 million and unliquidated obligations of $11.3 million.

RESULTS OF REVIEW

We found that CA DDS had effective internal controls over the accounting and reporting of administrative costs and its general security control environment was effective. In addition, the costs claimed by CA-DDS were allowable and funds were properly drawn except for $1,658,596 of charges to SSA programs. This occurred because DSS claimed reimbursement for unallowable indirect, personnel, and nonpersonnel costs. Specifically, DSS

improperly allocated $1,544,050 of State-wide indirect costs to SSA programs,

paid medical consultants $46,656 in unallowable costs,

charged $38,847 from components that did not benefit SSA, and

paid $29,043 in rental costs in excess of lease agreements.

EXCESS STATE-WIDE INDIRECT COSTS ALLOCATED TO SSA PROGRAMS

DSS improperly charged State-wide indirect costs to SSA's programs. According to DSS personnel, this occurred because adjustments to the proposed State-wide costs were not made after the actual costs were approved. As a result, SSA reimbursed DSS $1,544,050 of unallowable costs from July 2001 through June 2005 (see Table 1). Beginning in July 2005, DSS did properly adjust the proposed State-wide costs.

State-wide indirect costs are expenditures for services, including accounting, auditing, budgeting, and payroll from the California Department of Finance (DOF), Office of the State Controller, and State Personnel board, that benefit all departments in the State. A State-wide indirect cost pool is used to allocate an equitable share of State-wide costs to all programs benefiting from these services. At the beginning of each State FY, DOF issues the proposed State-wide indirect costs to be used until the State-wide indirect costs are approved.

Beginning July 1998, DOF stopped notifying all State departments, in writing, of any revisions to the proposed State-wide indirect costs. Instead, DOF required that State departments review its website for any revisions to the proposed State-wide indirect costs. Because DSS employees did not review the DOF website, they were not aware of the subsequent adjustments to the proposed State-wide indirect costs. This finding was reported in our May 2003 audit of FYs 1999 and 2000. DSS refunded the excess costs and agreed with our recommendations to periodically review the DOF website for any revisions to the proposed State-wide indirect costs. As a result of our current audit, DSS advised us that it refunded the unallowable indirect costs.

UNALLOWABLE COSTS CLAIMED FOR MEDICAL CONSULTANTS

CA DDS claimed unallowable costs paid to medical consultants. This occurred because of control weaknesses that allowed medical consultants to receive additional pay to which they were not entitled. As a result, we estimate that SSA reimbursed DSS $46,656 of unallowable costs for October 2004 through September 2005 (see Appendix C).

Medical consultants are employed by CA-DDS and receive a salary for their review of the medical aspects of disability claims. CA DDS provides medical consultants an additional $27 for each case closed over an established weekly minimum threshold (90 cases for a full time medical consultant). To receive the additional payment, the medical consultants must complete and certify a Case Closure Bonus Certification form. The medical consultants then submit the certification and a log of their cases completed and closed to a supervisor for review and approval.

We found that the supervisory review and approval of the Case Closure Bonus Certification did not always detect (1) duplicate cases claimed, (2) instances in which medical consultants claimed extra cases without meeting their minimum thresholds, and (3) instances in which the number of extra cases claimed on the certification forms exceeded the number supported by the logs.

Because of the control weaknesses in the certification and approval process, we reviewed all payments made to medical consultants for extra cases closed for a 1 month period (July 2005). During that month, 15 of the 168 medical consultants received $52,056 in bonus payments. Of these, CA DDS overpaid $4,698 to
11 medical consultants. In addition, 2 medical consultants were underpaid $810 for
30 cases. As a result, we estimate CA DDS overpaid the 11 medical consultants $56,376 and underpaid the 2 medical consultants $9,720 for October 2004 through September 2005 (see Appendix C).

IMPROPER CHARGES FROM COMPONENTS THAT DID NOT BENEFIT SSA

DSS improperly claimed nonpersonnel costs (for example, occupancy, equipment, communication, travel, and supplies) from components that did not benefit SSA's programs. This occurred because DSS employees erroneously coded these expenditures as CA DDS costs. For our audit period, DSS charged $69,981 in nonpersonnel costs from these components, of which we verified that $38,847 was erroneously coded and charged to SSA's programs.

Applicable Federal guidance states that "a cost is allocable to a particular cost objective if the goods or services involved are chargeable or assignable to such cost objective in accordance with relative benefits received." SSA's procedures authorize the Agency to provide States with funding for all expenditures, direct or indirect, necessary to make disability determinations. Generally, any expenditures incurred for SSA's disability determination process are deemed essential and may be charged to the Agency.

During our audit, we identified charges from the Children and Family Services Division, which is responsible for adoption services and overseeing the Child Welfare Service program. Also, we found charges from the Adult Programs and State Disability Programs Branches in the Disability and Adult Programs Division. The Adult Programs Branch oversees State programs for the aged, blind, or disabled, and the State Disability Programs Branch develops, evaluates, and adjudicates Medicaid claims. Generally, these components' activities did not benefit SSA's programs.

OVERPAYMENT OF LEASE FOR CA-DDS BRANCHES

We found DSS had overpaid rental costs for three CA DDS branches. This occurred because DSS employees did not ensure the rental payments made agreed with the amounts in the lease agreements. As a result, DSS claimed $29,043 in unallowable rental costs for the Los Angeles East, Los Angeles South, and Sacramento branches.

The Los Angeles East and South branches are co located in a privately owned building. These branches entered into one lease agreement with the lease amount divided equally and charged to their respective accounts. The total lease amount for these two branches during our review period was $2,112,826. We found that DSS paid $2,134,883. As a result, DSS overpaid $22,057 in rental cost for the two branches.

The Sacramento branch is located in a privately owned building. Under the terms of its lease agreement, the total lease amount was $1,588,892. We found that DSS paid $1,595,878 and therefore overpaid $6,986 in rental costs for the Sacramento branch.

CONCLUSION AND RECOMMENDATIONS

Our review disclosed that CA DDS incorrectly charged costs to SSA programs. This occurred because DSS claimed reimbursement for unallowable indirect, personnel, and nonpersonnel costs. As a result, SSA reimbursed the CA DDS for $1,658,596 of unallowable costs.

We recommend that SSA:

1. Instruct DSS to refund $1,544,050 of unallowable statewide indirect costs.

2. Instruct DSS to ensure it adjusts the proposed Statewide costs after the actual costs are approved.

3. Instruct DSS to refund $46,656 of unallowable personnel costs paid to medical consultants or verify whether medical consultants' bonus payments were proper.

4. Instruct CA DDS to improve its controls to prevent and detect improper payments made to medical consultants for cases closed in excess of their weekly minimum thresholds.

5. Instruct DSS to refund $38,847 of unallowable nonpersonnel costs charged from components that did not benefit SSA's programs.

6. Instruct DSS to issue reminders to all employees on the proper method of charging nonpersonnel costs to SSA's programs.

7. Instruct DSS to refund $29,043 of unallowable rental costs for the Los Angeles East, Los Angeles South, and Sacramento branches or submit documentation to support the payment of rent in excess of the lease agreements.

8. Instruct DSS to improve its controls to ensure that rental costs claimed do not exceed the amounts in the lease agreements.

AGENCY COMMENTS

SSA agreed with all our recommendations. DSS generally agreed with our findings and recommendations. However, it disagreed in part with the unallowable rental costs and Recommendations 7 and 8. Specifically, DSS stated it has the documentation we recommended it provide to support the payment of rent in excess of the lease agreements.

See Appendices D and E for the full text of SSA's and DSS' comments.

OIG RESPONSE

We are pleased that SSA agreed with all our recommendations. Regarding the unallowable rental costs, the San Francisco Regional Office should ensure the DSS documentation adequately supports the payment of rent in excess of the lease agreements.

Patrick P. O'Carroll, Jr.

Appendices
APPENDIX A - Acronyms
APPENDIX B - Scope and Methodology
APPENDIX C - Sampling Methodology, Results and Estimates
APPENDIX D - Social Security Administration Comments
APPENDIX E - California Disability Determination Services Comments
APPENDIX F - OIG Contacts and Staff Acknowledgments

Appendix A
Acronyms
Act Social Security Act
CA DDS California Disability Determination Services
C.F.R. Code of Federal Regulations
DDS Disability Determination Services
DOF California Department of Finance
DSS California Department of Social Services
FY Fiscal Year
POMS Program Operations Manual System
SSA Social Security Administration
U.S.C. United States Code

Appendix B
Scope and Methodology

SCOPE
We reviewed the administrative costs reported to the Social Security Administration (SSA) by the California Disability Determination Services (CA DDS) on the State Agency Report of Obligations for SSA Disability Programs (Form SSA 4513) for Federal Fiscal Years (FY) 2004 and 2005. As of September 30, 2005, CA DDS reported the following disbursements and unliquidated obligations on its Forms SSA 4513.

Category FY 2004 FY 2005
Disbursements
Personnel Costs $106,091,158 $111,114,952
Medical Costs 46,834,955 41,587,770
Indirect Costs 19,375,268 19,077,606
All Other Nonpersonnel Costs 15,881,044 15,764,820
Total Disbursements 188,182,425 187,545,148
Unliquidated Obligations 578,424 10,696,746
Total Obligations $188,760,849 $198,241,894

To accomplish our objective, we:

Reviewed applicable Federal laws and regulations, pertinent sections of SSA's Program Operations Manual System, and other criteria relevant to administrative costs claimed by CA DDS and drawdowns of SSA program funds.

Reviewed California Department of Social Services' (DSS) policies and procedures related to personnel, medical, indirect, and all other nonpersonnel costs.

Interviewed employees from the SSA regional office, DSS, CA DDS.

Reviewed the Single Audit of the State of California for the FY ended June 30, 2002.

Reviewed the corrective actions DSS took on our May 2003 Audit of Administrative Costs Claimed by the California Disability Determination Services (A 09 02 22022).

Obtained an understanding of the internal control structure to plan the audit and to determine the nature, timing, and extent of the tests to be performed.

Reconciled the amount of Federal funds drawn for support of program operations to the allowable expenditures.

Examined the administrative costs incurred and claimed by DSS for personnel, medical, indirect, and all other nonpersonnel costs during FYs 2004 and 2005.

Reconciled the accounting records to the administrative costs reported by DSS on the Forms SSA 4513 for FYs 2004 and 2005.

Selected a random sample of personnel, medical, and all other nonpersonnel costs.

Verified indirect costs for FYs 2004 and 2005 based on the approved indirect cost allocation plan.

Conducted a limited examination of CA DDS' general security controls environment.

We determined the electronic data used in our audit were sufficiently reliable to achieve our audit objectives. We assessed the reliability of the electronic data by reconciling them with the costs claimed on the Form SSA 4513. We also conducted detailed audit testing on selected data elements from the electronic files.

We performed audit work at DSS and CA DDS in Sacramento, California, and at the San Francisco Regional Office in Richmond, California. We also performed audit work at two CA DDS branch offices in Sacramento and Oakland, California. We conducted fieldwork between August 2006 and April 2007. We conducted our audit in accordance with generally accepted government auditing standards.

SAMPLING METHODOLOGY

Our sampling methodology included the three general areas of costs as reported on Form SSA 4513: (1) personnel, (2) medical, and (3) all other nonpersonnel costs. We obtained computerized data from DSS and CA DDS for FYs 2004 and 2005 for statistical sampling.

Personnel Costs

We reviewed a random sample of 50 personnel and 50 medical consultant transactions for 1 month in FY 2005. We tested payroll records to ensure CA DDS accurately paid its employees and adequately supported these payments.

Medical Costs

We reviewed 100 medical cost items (50 items from each FY) using a stratified random sample. We distributed the sample items between medical evidence of records and consultative examinations based on the proportional distribution of the total medical costs for each year.

All Other Nonpersonnel Costs

We reviewed 100 all other nonpersonnel costs items (50 items from each FY) using a stratified random sample. Before selecting our sample, we excluded $1,746,576 from our population that we reviewed separately. We excluded these items because those costs could not be clearly identified with specific invoices that can be associated with the CA DDS or other benefiting component. We then sorted the remaining transactions into the following categories: (1) Occupancy (less Occupancy Rent), (2) Contracted Costs, (3) Electronic Data Processing Maintenance, (4) New Electronic Data Processing Equipment, (5) Equipment, (6) Communications, (7) Applicant Travel, (8) DDS Travel, (9) Supplies, and (10) Miscellaneous. We then distributed the 50 sample items between these categories based on the proportional distribution of all other nonpersonnel costs for each year. In addition, we reviewed all transactions for rental costs for each year.

Appendix C
Sampling Methodology, Results and Estimates
MEDICAL CONSULTANTS
We obtained a list of individuals employed by the California Disability Determination Service (CA DDS). From this list, we identified a population of 168 medical consultants, of which 15 received additional pay in the randomly selected month of July 2005. The 15 medical consultants received the additional pay for cases closed over their established weekly minimum threshold.

For each of the 15 medical consultants, we obtained payroll records, personnel forms, and other supporting documentation to determine whether the amounts paid were accurate and valid. We found that 11 medical consultants were overpaid $4,698 because of (1) duplicate cases claimed, (2) instances in which medical consultants claimed extra cases but did not meet their minimum thresholds, and (3) instances in which the number of extra cases medical consultants claimed on their certification forms exceeded the number supported by their logs. In addition, two medical consultants were underpaid $810 because extra cases completed were not included for payment on the claim forms.

We estimate that the CA-DDS overpaid the 11 medical consultants $56,376 and underpaid the 2 medical consultants $9,720 for October 2004 through September 2005. The following tables provide the details of our audit results and estimates.

Table 1 - Annual Estimate for Overpayments
Sample Results Annual Estimates
Type of Error Number of Medical Consultants Number of Cases Overpaid amount Number of Cases Overpaid Amount
Duplicates 10 110 $2,970 1,320 $35,640
Threshold Not Met 2 44 $1,188 528 $14,256
Not Documented 2 20 $540 240 $6,480
Total 11 174 $4,698 2,088 $56,376
Table 2 - Annual Estimate of Underpayments
Sample Results Annual Estimates
Type of Error Number of Medical Consultants Number of Cases Overpaid amount Number of Cases Underpaid Amount
Unclaimed 2 30 $810 360 $9,720

Appendix D
Social Security Administration Comments

SOCIAL SECURITY

MEMORANDUM

Date: July 13, 2007

To: Inspector General

From: Regional Commissioner San Francisco

Subject: Audit of Administrative Costs Claimed by the California Disability Determination Services (A-09-06-16129)--REPLY

Thank you for the opportunity to review the draft report of your audit of the California Disability Determination Services. Per your request, we are providing an attachment with specific written comments for each of the eight recommendations contained in the draft report.

We greatly appreciate the work performed by the OIG staff in this region. They display consistent dedication to improving the fiscal efficiency of our DDSs.

If you have any questions regarding our comments, please call me. If your staff has any questions, they may call Gus Villalobos in the Center for Disability at (510) 970-8297.

Peter D. Spencer

Regional Office Comments on the California DDS Draft Audit Report

Recommendation 1: Instruct DSS to refund $1,544,050 of unallowable statewide indirect costs.

Comment: We agree with this recommendation.

Recommendation 2: Instruct DSS to ensure it adjusts the proposed statewide costs after the actual costs are approved.

Comment: We agree with this recommendation.

Recommendation 3: Instruct DSS to refund $46,656 of unallowable personnel costs paid to medical consultants' or verify whether medical consultants' bonus payments were proper.

Comment: We agree with the auditor finding. We would like to see the State response before deciding on a reasonable resolution to the finding.

Recommendation 4: Instruct the California DSS to improve its controls to prevent and detect improper payments made to medical consultants for cases closed in excess of their weekly minimum thresholds.

Comment: We agree with this recommendation:

Recommendation 5: Instruct DSS to refund $38,847 of unallowable non-personnel costs charged from components that did not benefit SSA's programs.

Comment: We agree with this recommendation.

Recommendation 6: Instruct DSS to issue reminders to all employees on the proper method of charging non-personnel costs to SSA's programs.

Comment: We agree with this recommendation.

Recommendation 7: Instruct DSS to refund $29,043 of unallowable rental costs for the Los Angeles East, Los Angeles South, and Sacramento branches or submit documentation to support the payment of rent in excess of the lease agreements.

Comment: We agree with this recommendation.

Recommendation 8: Instruct DSS to improve its controls to ensure that rental costs claimed do not exceed the amounts in the lease agreements.

Comment: We agree with this recommendation.

Appendix E
California Disability Determination Services Comments

Appendix F
OIG Contacts and Staff Acknowledgments
OIG Contacts
James J. Klein, Director, San Francisco Audit Division, (510) 970-1739
Joseph Robleto, Audit Manager, (510) 970-1737
Acknowledgments
In addition to those named above:
Wilfred P.K. Wong, Auditor in Charge
Nicole Kato Sullivan, Auditor

For additional copies of this report, please visit our web site at www.socialsecurity.gov/oig or contact the Office of the Inspector General's Public Affairs Specialist at (410) 965 3218. Refer to Common Identification Number A-09-06-16129.

Overview of the Office of the Inspector General
The Office of the Inspector General (OIG) is comprised of our Office of Investigations (OI), Office of Audit (OA), Office of the Chief Counsel to the Inspector General (OCCIG), and Office of Resource Management (ORM). To ensure compliance with policies and procedures, internal controls, and professional standards, we also have a comprehensive Professional Responsibility and Quality Assurance program.

Office of Audit
OA conducts and/or supervises financial and performance audits of the Social Security Administration's (SSA) programs and operations and makes recommendations to ensure program objectives are achieved effectively and efficiently. Financial audits assess whether SSA's financial statements fairly present SSA's financial position, results of operations, and cash flow. Performance audits review the economy, efficiency, and effectiveness of SSA's programs and operations. OA also conducts short term management and program evaluations and projects on issues of concern to SSA, Congress, and the general public.

Office of Investigations
OI conducts and coordinates investigative activity related to fraud, waste, abuse, and mismanagement in SSA programs and operations. This includes wrongdoing by applicants, beneficiaries, contractors, third parties, or SSA employees performing their official duties. This office serves as OIG liaison to the Department of Justice on all matters relating to the investigations of SSA programs and personnel. OI also conducts joint investigations with other Federal, State, and local law enforcement agencies.

Office of the Chief Counsel to the Inspector General
OCCIG provides independent legal advice and counsel to the IG on various matters, including statutes, regulations, legislation, and policy directives. OCCIG also advises the IG on investigative procedures and techniques, as well as on legal implications and conclusions to be drawn from audit and investigative material. Finally, OCCIG administers the Civil Monetary Penalty program.

Office of Resource Management
ORM supports OIG by providing information resource management and systems security. ORM also coordinates OIG's budget, procurement, telecommunications, facilities, and human resources. In addition, ORM is the focal point for OIG's strategic planning function and the development and implementation of performance measures required by the Government Performance and Results Act of 1993.