Summary

In 1993, the Social Security Administration's (SSA) Disability Insurance program provided nearly $35 million to 5.3 million disabled workers and their dependents and the Supplemental Insurance Income program provided about $24 billion to 6 million recipients. Although SSA runs these programs, state agencies determine whether claimants are disabled according to program rules. In recent years, disability benefit claims have soared and the two programs have been unable to keep up with the high rate of claims submitted. In response to congressional concerns about the increasing workload pressures on the quality of disability determinations, this report evaluates (1) the reliability of SSA's reported accuracy rates and (2) how well SSA's quality assurance mechanism ensures the accuracy and consistency of state agencies' disability determinations and minimizes erroneous payments.

GAO found that: (1) although SSA has reported a 94-percent accuracy rate for state disability determination services' (DDS) determinations, many people question the reliability of the accuracy rate; (2) the SSA review program is not designed to assess errors, except when eligibility judgments are clearly wrong; (3) SSA is attempting to reengineer, rethink, and redesign its disability determination process to improve the quality of DDS determinations; (4) SSA needs to ensure that QA reviewers use performance accuracy standards effectively; (5) SSA has not reviewed the effectiveness of its accuracy standards since 1980; (6) the effective use of accuracy standards can improve the quality of DDS determinations; (7) although DDS internal QA programs are critical to correcting errors, SSA has not ensured the effective design and operation of internal DDS QA programs; and (8) SSA mass preeffectuation review is a cost-effective interim quality control mechanism, has helped DDS increase the accuracy of their DI determinations, and has saved more than $2 billion in unnecessary trust fund expenditures.