Major Causes of RSDI Improper Payments
The table below indicates the major causes of improper payments (overpayments and underpayments) in FY 2015 for the RSDI program using OMB’s categories of error:
Improper Payment Root Cause Category Matrix for FY 2015
(dollars in millions)
|
OASDI Program |
|
Reason for Improper Payment |
Overpayments |
Underpayments |
Program Design or Structural Issue |
$0 |
$0 |
Inability to Authenticate Eligibility |
$163.63 |
$52.54 |
Failure to Verify: |
|
|
Death Data |
$1.02 |
$9.08 |
Financial Data |
$0 |
$0 |
Excluded Party List |
$0 |
$0 |
Prisoner Data |
$247 |
$0 |
Other Eligibility Data |
$1,985.34 |
$27.31 |
Administrative or Process Error Made by: |
|
|
Federal Agency |
$702.42 |
$482.83 |
State or Local Agency |
$0 |
$0 |
Other Party (e.g., participating |
$0 |
$0 |
Medical Necessity |
$0 |
$0 |
Insufficient Documentation to Determine |
$0 |
$0 |
Other Reason (a) (explain) |
$0 |
$0 |
Other Reason (b) (explain) |
$0 |
$0 |
TOTAL |
$3,100.40 |
$571.76 |
The following tables indicate the major causes of RSDI overpayments and underpayments,
for FYs 2011 - 2015, as determined from our payment accuracy reviews:
| Major Causes of RSDI Overpayments FY 2011 – FY 2015 | |
|---|---|
| SGA | When a disability beneficiary works, a number of factors determine if the individual can continue to receive monthly benefits. After completing a nine-month trial work period, we do not pay a beneficiary for months when earnings exceed SGA thresholds. Overpayments occur when beneficiaries fail to timely report earnings, or when we do not timely withhold monthly benefit payments from those engaging in SGA. |
| Computations | We determine an individual’s benefit amount based on a number of factors, including age, earnings history, and the type of benefit awarded. Inaccurate information or administrative errors can result in incorrectly calculated benefits. In terms of overpayments, computation errors involving the Windfall Elimination Provisions are the leading cause of deficiencies. |
| Major Cause of RSDI Underpayments FY 2011 – FY 2015 | |
|---|---|
| Computations | We determine an individual’s benefit by using several factors such as age, earnings history, and the type of benefit awarded. Inaccurate information or administrative mistakes can cause errors in benefits. |