The Social Security Administration (SSA) needs to focus on “program integrity,” a polite term for reducing fraud and payment errors, the agency’s inspector general told Congress last week.
Reducing improper payments is one of the challenges facing the next SSA commissioner, Patrick O’Carroll, Jr., the agency’s inspector general, told the House Ways and Means Subcommittee on Social Security on April 26.
In fiscal year 2012, the Social Security Administration reported $4.7 billion in improper payments in the Supplemental Security Income (SSI) program, a 9.2 percent improper payment rate. (SSI is funded by general tax revenues, not payroll taxes. It helps elderly, blind, and/or disabled people who are poor.)
SSA reported $3.2 billion in the Old-Age, Survivors’ and Disability Insurance (OASDI) program, a 0.4 percent improper payment rate. (OASDI, funded by payroll taxes, is what people generally refer to as “Social Security.”)
That’s a total of $7.9 billion, and it includes some underpayments as well as overpayments.
“SSA’s improper payments largely consist of those erroneously made to ineligible individuals,” O’Carroll said.
“Improper benefit payments occur for many reasons.” Fraud is one reason, he said. This includes beneficiaries who do not tell the agency about changes in their income, resources or living arrangements, which would change the amount Social Security pays them. O’Carroll also mentioned recipients’ “poor understanding of reporting responsibilities,” and administrative errors.
“For many years, my office has encouraged SSA to balance service initiatives, such as processing new claims, with stewardship responsibilities, such as conducting timely work and medical (disability reviews) and SSI redeterminations, to ensure that individuals remain disabled and eligible, and cease payments to those who do not.”
Soaring disability claims are a particular concern for the Social Security Administration.
In his opening statement, subcommittee Chair Rep. Sam Johnson (R-Texas) said application for disability benefits, triggered by the recession and the weak recovery, have never been higher: “Since 2010, the average number of people filing for disability benefits is just over 249,000 a month,” Johnson said. “At the same time the average number of new jobs created is almost 148,000 each month.”
O’Carroll told the panel he would like to see SSA perform more work-related “continuing disability reviews,” or CDRs, to make sure people collecting disability aren’t working on the side.
SSA estimates that every dollar spent on medical CDRs yields about $9 in SSA program savings over 10 years. Reducing the complexity of Social Security’s disability programs could also streamline operations and reduce millions of dollars in payment errors each year, O’Carroll said.
SSA said it conducted 443,233 medical disability reviews in FY2012, up from 345,000 in FY2011, but the disability review backlog still stands at 1.2 million.
SSA has set a goal of conducting 435,000 medical disability reviews in FY2013, based on the current level of funding. Beneficiaries with a high likelihood of medical improvement undergo a medical review; Beneficiaries with a lower likelihood of medical improvement are mailed a questionnaire, which may or may not trigger a medical review.
Reexamination or “redetermination” of SSI retirement benefits also is effective in reducing overpayments in the SSI program, O’Carroll said. Because SSI is a means-tested program, any change in recipients’ income, living arrangements, or marital status can affect eligibility or payment amount.
SSA reported that it saves $5 for every $1 spent on SSI redeterminations. SSA completed more than 2.4 million redeterminations in FY2011 and 2.6 million in FY2012, and it plans to conduct more than 2.6 million in FY2013. Not every SSI recipient undergoes a redetermination every year; SSA uses a statistical scoring model to identify which cases it will examine.
O’Carroll said his office has encouraged SSA to use data matching with other governmental agencies to detect improper payments. He said SSA also should use more non-governmental databases in doing the redeterminations.
SSA paid more than $800 billion in SSI and OASDI benefits to more than 60 million Americans in FY2012. It estimates that over the next 20 years, another 80 million individuals will retire and file for Social Security benefits.
The hearing was called to discuss the challenges facing the next Social Security commissioner. Michael J. Astrue’s six-year term expired on Jan. 19, 2013, and his successor — once President Obama nominates one – must be confirmed by the Senate.