    Supplemental Security Income: Action Needed on Long-Standing Problems
    Affecting Program Integrity (Chapter Report, 09/14/98, GAO/HEHS-98-158).

    GAO provided information on the management problems associated with the
    Social Security Administration's (SSA) Supplemental Security Income
    (SSI) Program.

    GAO noted that: (1) to a great extent, SSA's inability to address its
    most significant long-standing SSI problems is attributable to two
    underlying causes: (a) an organizational culture or value system that
    places a greater priority on processing and paying claims than on
    controlling program expenditures; and (b) a management approach
    characterized by SSA's reluctance to fulfill its policy development and
    planning role in advance of major program crises; (2) SSA's
    organizational culture has traditionally valued quickly processing and
    paying SSI benefit claims more highly than controlling program
    expenditures by ensuring that only eligible individuals receive
    benefits; (3) other important financial controls such as aggressively
    pursuing the recovery of overpaid funds and combatting SSI fraud have
    also often received inadequate attention; (4) SSI problem resolution and
    program direction have also been hindered by SSA's hesitance to take a
    leadership role in SSI research and policy development, and its tendency
    to react to resulting crises through a series of ad hoc initiatives; (5)
    SSA's management approach was most evident regarding its reluctance to
    play a leadership role in recent policy debates surrounding SSI
    eligibility for children and substance abusers, and its failure to
    devise a comprehensive strategy to help SSI recipients return to work;
    (6) program direction has been further impaired by SSA's reluctance to
    develop agencywide plans that adequately focus on the specific
    characteristics and needs of the SSI program and its recipients; (7)
    SSA's current plans do not adequately communicate SSI priorities, goals,
    and objectives to staff; (8) reversing how the SSI program has
    traditionally operated will require sustained and expanded attention to
    developing and promoting tighter payment controls, increasing SSA's role
    in SSI research and policy formulation, and a willingness to define a
    long-term vision and strategy for improving program performance; (9)
    recently, SSA has initiated several measures aimed at improving the
    financial integrity of the SSI program; (10) as required by the
    Government Performance and Results Act of 1993, SSA also intends to
    develop a comprehensive SSI Action Plan in fiscal year 1998, which will
    serve as a blueprint for long-term program operations; and (11) however,
    such a plan has not yet been developed, and decisive action is needed to
    ensure that SSA will focus on those program areas that pose the greatest
    management challenges and that corrective actions will be implemented
    and sustained over time.

    --------------------------- Indexing Terms -----------------------------

     REPORTNUM:  HEHS-98-158
         TITLE:  Supplemental Security Income: Action Needed on
                 Long-Standing Problems Affecting Program Integrity
          DATE:  09/14/98
       SUBJECT:  Social security benefits
                 Program abuses
                 Overpayments
                 Income maintenance programs
                 Internal controls
                 Eligibility determinations
                 Claims processing
                 Reporting requirements
                 Program management
                 Fraud
    IDENTIFIER:  Supplemental Security Income Program

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    Cover
    ================================================================ COVER

    Report to the Commissioner of Social Security

    September 1998

    SUPPLEMENTAL SECURITY INCOME -
    ACTION NEEDED ON LONG-STANDING
    PROBLEMS AFFECTING PROGRAM
    INTEGRITY

    GAO/HEHS-98-158

    SSI Program Integrity

    (105153)

    Abbreviations
    =============================================================== ABBREV

      ALJ - administrative law judge
      CBO - Congressional Budget Office
      CDR - continuing disability review
      DA&A - drug addicts and alcoholics
      DDS - Disability Determination Services
      DI - Disability Insurance
      HCFA - Health Care Financing Administration
      IFA - individualized functional assessment
      OASI - Old Age and Survivors Insurance
      OCSE - Office of Child Support Enforcement
      OHA - Office of Hearings and Appeals
      OIG - Office of Inspector General
      PASS - plan for achieving self-support
      SGA - substantial gainful activity
      SSA - Social Security Administration
      SSI - Supplemental Security Income
      TRO - tax refund offset
      VR - vocational rehabilitation

    Letter
    =============================================================== LETTER

    B-278097

    September 14, 1998

    The Honorable Kenneth S.  Apfel
    Commissioner of Social Security

    Dear Mr.  Apfel:

    This report, prepared at our own initiative, discusses management
    problems associated with the Social Security Administration's
    Supplemental Security Income program.

    The report contains recommendations to you.  As you know, 31 U.S.C.
    720 requires the head of a federal agency to submit a written
    statement of actions taken on our recommendations to the Senate
    Committee on Governmental Affairs and the House Committee on
    Government Reform and Oversight no later than 60 days after the date
    of the report and to the House and Senate Committees on
    Appropriations with the agency's first request for appropriations
    made more than 60 days after the date of this report.

    We are sending copies of this report to appropriate congressional
    committees and Members of Congress, and the Director of the Office of
    Management and Budget.  We will also make copies available to other
    interested parties.

    The major contributors to this report are listed in appendix III.

    Sincerely yours,

    Cynthia M.  Fagnoni
    Director, Income Security Issues

    EXECUTIVE SUMMARY
    ============================================================ Chapter 0

       PURPOSE
    ---------------------------------------------------------- Chapter 0:1

    The Social Security Administration (SSA) operates the Supplemental
    Security Income (SSI) program, which is the nation's largest cash
    assistance program for the poor.  In 1996, the SSI program paid about
    6.6 million aged, blind, and disabled recipients more than $25
    billion in benefits.  Since its inception in 1974, the SSI program
    has grown in both size and complexity, and SSA has been significantly
    challenged in its efforts to serve the diverse needs of recipients
    while still protecting the financial health and integrity of the
    program.  Reports in the media and by oversight agencies have
    highlighted program abuses and mismanagement, increasing SSI
    overpayment, and SSA's inability to adequately recover outstanding
    SSI debt.  These and other problems documented over the years have
    spurred congressional criticism of SSA's ability to effectively
    manage SSI workloads and have also served to reinforce public
    perceptions that SSA pays SSI benefits to too many people for too
    long.  The SSI program's vulnerability to fraud and abuse, and the
    magnitude of overpayments involved, were primary factors in GAO's
    decision to designate SSI a high-risk program in 1997\1 and to begin
    this larger body of work to document the underlying causes of
    long-standing SSI program problems and the impact these problems have
    had on program performance and integrity.

    --------------------
    \1 High Risk Series:  An Overview (GAO/HR-97-1, Feb.  1997).  In
    1990, GAO began a special effort to review and report on federal
    program areas its work identified as high risk because of
    vulnerabilities to waste, fraud, and mismanagement.

       BACKGROUND
    ---------------------------------------------------------- Chapter 0:2

    Between 1974 and 1996, the number of SSI recipients increased almost
    65 percent from about 4 million to about 6.6 million, and federal
    benefit payments rose 565 percent from $3.8 billion to more than $25
    billion.  In fiscal year 1997, outstanding SSI debt and newly
    detected overpayments for the year totaled $2.6 billion.  SSA
    recovered $437 million in that year--about 17 percent of the total
    amount--and wrote off $562 million in overpayment debt.

    Our prior work shows that the SSI program has experienced several
    long-standing problems that have affected SSA's ability to protect
    the financial integrity of the program and provide effective
    management direction.  These problems include (1) inadequate
    attention to verifying recipients' initial and continuing eligibility
    for SSI benefits, (2) a lack of priority given to recovering SSI
    overpayments, (3) insufficient attention to addressing program fraud
    and abuse, and (4) ineffective SSI policy development and program
    planning.

       RESULTS IN BRIEF
    ---------------------------------------------------------- Chapter 0:3

    To a great extent, SSA's inability to address its most significant
    long-standing SSI problems is attributable to two underlying causes:
    an organizational culture or value system that places a greater
    priority on processing and paying claims than on controlling program
    expenditures, and a management approach characterized by SSA's
    reluctance to fulfill its policy development and planning role in
    advance of major program crises.

    SSA's organizational culture has traditionally valued quickly
    processing and paying SSI benefit claims more highly than controlling
    program expenditures by ensuring that only eligible individuals
    receive benefits.  Thus, SSA has often relied heavily on
    self-reported recipient information when determining SSI eligibility,
    which it has tried to validate with untimely and incomplete
    verification processes.  Other important financial controls such as
    aggressively pursuing the recovery of overpaid funds and combatting
    SSI fraud have also often received inadequate attention.

    SSI problem resolution and program direction have also been hindered
    by SSA's hesitance to take a leadership role in SSI research and
    policy development, and its tendency to react to resulting crises
    through a series of ad hoc initiatives.  SSA's management approach
    was most evident regarding its reluctance to play a leadership role
    in recent policy debates surrounding SSI eligibility for children and
    substance abusers, and its failure to devise a comprehensive strategy
    to help SSI recipients return to work.  Program direction has been
    further impaired by SSA's reluctance to develop agencywide plans that
    adequately focus on the specific characteristics and needs of the SSI
    program and its recipients.  Thus, SSA's current plans do not
    adequately communicate SSI priorities, goals, and objectives to
    staff.  As a result, inefficient policies and procedures often
    continue longer than they should have or are never addressed.

    Reversing how the SSI program has traditionally operated will require
    sustained and expanded attention to developing and promoting tighter
    payment controls, increasing SSA's role in SSI research and policy
    formulation, and a willingness to define a long-term vision and
    strategy for improving program performance.  Recently, SSA has
    initiated several measures aimed at improving the financial integrity
    of the SSI program.  The agency has also acknowledged the need to
    reassess its approach to SSI policy development.  As required by the
    Government Performance and Results Act of 1993,\2 SSA also intends to
    develop a comprehensive SSI Action Plan in fiscal year 1998, which
    will serve as a blueprint for long-term program operations.  However,
    such a plan has not yet been developed, and decisive action is needed
    to ensure that SSA will focus on those program areas that pose the
    greatest management challenges and that corrective actions will be
    implemented and sustained over time.

    --------------------
    \2 The Results Act requires federal agencies to implement
    results-oriented management reforms, such as strategic planning,
    establishing program goals and objectives, measuring their progress
    in meeting those goals, and reporting publicly on that progress.

       PRINCIPAL FINDINGS
    ---------------------------------------------------------- Chapter 0:4

          ORGANIZATIONAL CULTURE HAS
          PERPETUATED SEVERAL
          LONG-STANDING PROBLEMS
    -------------------------------------------------------- Chapter 0:4.1

    In work spanning more than a decade, GAO has noted that SSA's
    operations are heavily influenced by an organizational culture or
    value system that places a greater emphasis on quickly processing and
    paying claims than on controlling program costs or improving
    operational efficiency.  GAO's current work confirmed the continued
    existence of an agency culture that has tended to view the SSI
    program in much the same way as SSA's Old Age and Survivors Insurance
    and Disability Insurance programs--where emphasis is placed on
    quickly processing claims for individuals with an earned right to
    benefits--rather than as a welfare program where stronger income and
    asset verification is necessary.

    The agency's organizational culture has been strongly influenced by
    top management and is most evident in regard to SSA's (1) inadequate
    attention to verifying recipients' initial and continuing SSI
    eligibility, (2) lack of priority given to recovering SSI
    overpayments, and (3) insufficient attention to addressing program
    fraud and abuse.  More specifically, SSA is still not aggressively
    pursuing the most timely and complete sources of automated data to
    verify SSI financial eligibility--especially for nursing home
    admissions and the wages recipients may earn.  The agency also has
    not addressed long-standing vulnerabilities associated with
    determining recipient living arrangements--an area that SSA's quality
    reviewers have deemed to be highly prone to error, susceptible to
    manipulation, and a major source of SSI overpayments.

    SSA's culture has also contributed to the lack of priority placed on
    recovering overpayments once they are identified.  This is evidenced
    by SSA's reluctance to use overpayment recovery tools currently
    available to it and aggressively pursue additional tools when
    warranted, including tax refund offsets, credit bureau reporting,
    collection agencies, and interest levies on outstanding debt owed.
    Moreover, under current law, SSA cannot withhold more than 10 percent
    of a recipient's total monthly income to recover overpaid funds.\3
    Thus, SSA is limited in its ability to recover overpayments from
    individuals who chronically and willfully abuse SSI program reporting
    requirements.  SSA's own studies and data also show that field staff
    rarely apply existing penalty provisions to encourage recipients to
    report information in a timely manner.  Finally, SSA has not
    developed adequate measures of the activities and time necessary to
    develop fraud referrals.  Nor has SSA developed a means of
    recognizing staff for additional time they spend on developing fraud
    cases.  Thus, many staff may be unwilling to devote time to SSA's new
    anti-fraud activities, for which there is little reward.

    Recently, SSA has taken a number of actions to improve the financial
    integrity of the SSI program.  For example, SSA is expanding its use
    of on-line data maintained by state agencies to better verify
    recipient financial information, and is seeking an additional $50
    million for fiscal year 1999 to review the financial status of
    individuals who have been designated as having a high probability of
    being overpaid.  Following a series of GAO briefings with SSA's
    Deputy Commissioner and our recent testimony denoting SSA's
    reluctance to pursue more aggressive debt collection tools, SSA is
    also now seeking statutory authority to use credit bureaus, private
    collection agencies, interest levies, and other ways to recover more
    SSI overpayments.  The Office of Inspector General's investigative
    staffing levels have also been significantly increased over previous
    years, and that office has been more aggressive in pursuing those who
    defraud the program.  However, progress on some initiatives has been
    slow, and long-standing problems continue to affect SSI program
    integrity.  Reversing the trends in SSI program performance will
    require sustained attention to the issue of SSA's organizational
    culture and specific initiatives designed to facilitate a change in
    how SSI business is conducted, cases are processed, and staff and
    managers are rewarded for their efforts.

    --------------------
    \3 In contrast, in the Old Age and Survivors Insurance and Disability
    Insurance programs, SSA currently has the authority to withhold 100
    percent of a recipient's total monthly benefit until the overpayment
    is recovered.

          SSA'S MANAGEMENT APPROACH
          HAS HINDERED ADEQUATE
          PROGRAM DIRECTION
    -------------------------------------------------------- Chapter 0:4.2

    SSA's management approach is evident in its SSI policy development
    and program planning.  In prior work, GAO has reported that SSA
    should take a leadership role in identifying program problems before
    they reach crisis levels and developing comprehensive plans and
    strategies to address those problems.  However, SSA's approach to
    research and policy development has been reactive in nature,
    resulting in missed opportunities to address critical SSI policy
    issues.  Its planning activities have also been at such a general
    level that they provide inadequate programmatic direction.

    GAO's work shows that SSA has been reluctant to use its research and
    policy development capabilities to assess the impacts of demographic
    changes in the SSI population, legislation, and court-mandated
    program changes that have occurred over the years.  SSA has also
    often hesitated in initiating internal policy "fixes" to address
    identified problems or suggesting changes to laws governing SSI.  For
    example, in the recent congressional debate surrounding SSI
    eligibility for children, SSA did not take a leadership role in
    developing and communicating timely information to the Congress on
    the impacts of prior legislative and court-mandated changes.  SSA
    also did not develop its own proposals for revising childhood
    eligibility policies, despite possessing many years of data
    documenting explosive growth in childhood SSI rolls, changes in the
    types of impairments qualifying for benefits, and allegations that
    the program was being abused.  As a consequence, SSA missed an
    opportunity to provide policymakers with needed information to assess
    whether childhood disability laws were meeting the needs of the most
    severely disabled children.

    In other areas, SSA has often viewed itself as an implementer of
    program policies rather than as a leader in formulating a policy
    vision.  For example, SSA did not address, before the issue reached
    the crisis level, growing criticisms surrounding the rapid growth in
    the number of drug addicts and alcoholics qualifying for SSI benefits
    and reports of program abuses by recipients.  SSA has also been
    reluctant to take a leadership role in devising a comprehensive
    strategy for helping SSI recipients return to work.  In addition, SSA
    has not developed options for revising policies for determining SSI
    recipient living arrangements, despite acknowledging for many years
    that this program area is highly error-prone, open to manipulation by
    recipients, and a source of considerable SSI overpayments.

    Finally, SSA's strategic planning activities still do not provide
    clear direction necessary to address its most significant SSI program
    challenges.  Although SSA has developed an agencywide strategic plan
    and an annual performance plan as required by the Results Act, these
    plans still do not adequately focus on the specific needs and unique
    characteristics of the SSI program and its recipient population.
    Instead, SSA's planning efforts have resulted in general goals and
    objectives for SSA as a whole.  In the absence of an SSI-specific
    plan or strategy, SSA risks failing to address those aspects of the
    program that pose the greatest management challenge to the agency.

    SSA has acknowledged the need to play a more active policy
    development role and is currently in the process of restructuring its
    research and policy component to better address GAO's concerns in
    this area.  Last year, SSA also made conducting effective policy
    development, research, and program evaluation a key agency goal, with
    attention to the SSI program being an important element of this goal.
    However, only recently has SSA submitted any significant SSI policy
    proposals, and none has been enacted into law.  Finally, in its new
    annual performance plan, SSA has also made a commitment to complete a
    comprehensive action plan to improve the management of the SSI
    program in fiscal year 1998.  This step links with SSA's new
    strategic goal to make its programs the "best in business with zero
    tolerance for fraud and abuse." However, such a plan has not yet been
    completed.

       RECOMMENDATIONS TO THE
       COMMISSIONER OF SSA
    ---------------------------------------------------------- Chapter 0:5

    GAO is making several recommendations to the Commissioner of SSA,
    which, if implemented, should result in a change in SSA's
    organizational culture and enhance the financial integrity of the SSI
    program, as well as facilitate a change in SSA's management approach
    and improve SSI program direction.  These recommendations address
    needed operational and program policy changes essential to improving
    the financial verification aspects of the SSI program, aggressively
    deterring and recovering SSI overpayments, combatting program fraud
    and abuse, improving SSA's policy development role, and developing
    programmatic plans consistent with the Results Act.  The specific
    recommendations are presented in chapter 4 of this report.

       AGENCY COMMENTS AND GAO'S
       EVALUATION
    ---------------------------------------------------------- Chapter 0:6

    In its written comments on a draft of this report, SSA agreed that
    the SSI program faces significant challenges.  However, SSA disagreed
    with GAO's conclusion that it has historically placed greater
    emphasis on processing and paying SSI claims than on controlling
    program expenditures.  SSA was also concerned that the report did not
    adequately acknowledge the initiatives it has taken to improve the
    financial integrity of SSI.  GAO believes the evidence presented in
    this report supports its conclusion.  GAOs' review involved an
    extensive analysis of 200 internal and external studies of the SSI
    program dating back to its inception, more than 100 interviews of
    staff and managers at all levels of SSA, and an assessment of
    performance data encompassing nearly a decade of program operations.
    Throughout this report, GAO has also provided numerous examples of
    how SSA's emphasis on claims processing has led to internal control
    weaknesses, overpayments to ineligible recipients, and has
    contributed to a program environment where operating policies have
    not adequately protected taxpayer dollars from fraud and abuse.  GAO
    also believes the report fairly characterizes SSA's initiatives and
    accurately portrays their implementation status.  In other areas, SSA
    provided technical comments, which were addressed as appropriate.
    The full text of SSA's comments and GAO's response are included as
    appendix II.

    INTRODUCTION
    ============================================================ Chapter 1

    The Social Security Administration (SSA) administers three federal
    cash payment programs:  the Old Age and Survivors Insurance (OASI)
    program, the Disability Insurance (DI) program, and the Supplemental
    Security Income (SSI) program.  OASI and DI are social insurance
    programs authorized under title II of the Social Security Act that
    pay monthly benefits to eligible individuals or their families based
    on average annual earnings in covered employment.  These payments are
    made from the OASI and DI trust funds, which accumulate income
    derived from the mandatory payment of employment taxes.  In contrast,
    the SSI program is the nation's largest cash assistance program for
    the poor, and it is funded by general revenues.  SSI was authorized
    under title XVI of the Social Security Act to replace federal grants
    to similar state-administered programs.\4 The program ensures a
    minimum level of income for individuals who are aged, blind, or
    disabled, and who meet financial eligibility standards.  The monthly
    benefit amount is based on recipients' income and consists of a basic
    federal payment, and in some cases, a state supplement.  SSA was
    authorized to administer the SSI program because it already had a
    system in place for paying monthly benefits to large numbers of
    people, including a large number of field offices that could be used
    as contact points for those seeking information and benefits.

    Since its implementation, the SSI program has increased rapidly in
    both size and cost.  Between 1974 and 1996, the number of SSI
    recipients increased almost 65 percent from about 4 million to about
    6.6 million, and federal benefit payments rose about 565 percent from
    $3.8 billion to about $25.3 billion.  Program growth has been
    accompanied by dramatic changes in the make-up of the SSI recipient
    population as the proportion of the SSI caseload consisting of aged
    recipients has decreased, while the proportion of younger, mentally
    disabled recipients has increased dramatically.  Because these
    recipients tend to stay on the rolls longer, they are major
    contributors to increasing program costs.  Over time, changes in the
    SSI population and long-standing program problems have been
    accompanied by increasing overpayments.  In fiscal year 1997,
    outstanding SSI debt and newly detected overpayments for the year
    totaled $2.6 billion (see fig.  1).  SSA recovered only $437 million
    in that year or about 17 percent of the total amount.

       Figure 1.1:  Outstanding SSI
       Overpayment Debt and New
       Detected Overpayments, Fiscal
       Years 1989-97

       (See figure in printed
       edition.)

    Note:  Overpayments equal annual total beginning balance owed plus
    new detections for the year.

    Source:  SSA's Office of Finance, Assessment, and Management.

    --------------------
    \4 The SSI program was established by the Congress in 1972, with
    payments beginning in January 1974.

       AGENCY ORGANIZATION AND
       FUNCTIONS
    ---------------------------------------------------------- Chapter 1:1

    SSA is headed by a Commissioner who is responsible for administering
    the operations of the OASI, DI, and SSI programs.  According to the
    most recent agency data, SSA employs about 65,000 employees and
    serves the public through a network of 1,300 field offices located
    throughout 10 SSA regions.  The Commissioner and Deputy Commissioner
    head the management team and are responsible for addressing SSA's
    existing problems and managing its future challenges.  In addition to
    paying OASI, DI, and SSI benefits, SSA performs four basic functions
    in support of its programs.  These include issuing Social Security
    numbers, maintaining earnings information, making initial eligibility
    determinations for payments, and making changes to beneficiaries'
    accounts that affect their benefit payments (postentitlement
    activities).  To execute these activities, SSA is organized
    functionally into eight specialized components.  Each component is
    headed by a Deputy Commissioner whose responsibilities include
    supporting the agency's mission and objectives.  SSA also has an
    Office of Inspector General (OIG), which conducts audits and
    investigations of SSA's programs, as well as an Office of General
    Counsel that provides legal advice and litigation services for the
    agency.  (See app.  I for SSA's organizational chart.)

       DETERMINING SSI ELIGIBILITY
    ---------------------------------------------------------- Chapter 1:2

    To be determined eligible for SSI, individuals must be at least 65
    years of age, blind, or disabled.  Their income and assets also must
    be below certain limitations.  To qualify as disabled, applicants
    must be unable to engage in substantial gainful activity (SGA)
    because of an impairment that is expected to result in death or to
    last at least 12 months.\5 SSA relies on state Disability
    Determination Services (DDS) to make the initial medical
    determination of eligibility.  The DDSs are also required to help SSA
    identify candidates for return-to-work services and may refer
    eligible individuals to state vocational rehabilitation (VR) agencies
    for services such as counseling and job placement, as well as therapy
    and training.  Claimants whose initial disability claim is denied may
    request a reconsideration of their claim by different DDS staff.  If
    this review results in a confirmation of the original denial,
    claimants may appeal to an administrative law judge (ALJ) located in
    SSA's Office of Hearings and Appeals (OHA).  Claimants who disagree
    with an ALJ denial may request that the case be reviewed by SSA's
    Appeals Council.  After all SSA administrative remedies are
    exhausted, a claimant has further appeal rights within the federal
    court system, up to and including the U.S.  Supreme Court.

    SSA field staff are responsible for determining an individual's
    financial eligibility for SSI benefits.  To meet the financial
    requirements, individuals may not have combined income greater than
    the current maximum monthly benefit of $494 ($741 for a couple), or
    have resources worth more than $2,000 ($3,000 for a couple).  During
    the initial application process at SSA field offices, individuals are
    required to report any information that may affect their eligibility
    for benefits.  Similarly, once individuals receive SSI benefits, they
    are required to timely report events such as changes in income,
    resources, marital status, or living arrangements to SSA field office
    staff.

    To a significant extent, SSA depends on program applicants and
    recipients to accurately report important eligibility information.
    However, to determine whether recipients remain financially eligible
    for SSI benefits, SSA periodically conducts redeterminations.  These
    are reviews of financial eligibility factors such as income,
    resources, and living arrangements.  Recipients are reviewed at least
    every 6 years, but reviews may be more frequent if SSA determines
    that changes in eligibility are likely.  SSA also uses computer
    matches to determine recipients' continuing financial eligibility.
    Matches compare SSI payment records against recipient financial
    information contained in the payment files of third parties, such as
    other federal and state government agencies.  To determine whether a
    recipient has medically improved to the extent that he or she is no
    longer considered to be disabled, SSA also conducts periodic
    examinations called continuing disability reviews (CDR).

    --------------------
    \5 In 1997, the SGA threshold was $1,000 per month for blind
    recipients and $500 per month for individuals with other
    disabilities.

       THE SSI PROGRAM DIFFERS FROM
       THE OASI AND DI PROGRAMS
    ---------------------------------------------------------- Chapter 1:3

    SSI differs from OASI and DI in terms of its underlying program
    principles and eligibility requirements.  OASI and DI are intended to
    help protect working Americans and their survivors against the loss
    of income as a result of retirement, death, or disability.  These
    programs provide benefits to individuals who have worked a specified
    amount of time during which they contributed to the Social Security
    Trust Funds through employment taxes.  Determining financial
    eligibility for the OASI and DI programs is fairly easy and, once
    established, rarely changes.  For example, there normally is little
    difficulty in establishing whether an OASI or DI beneficiary has the
    required work for insured status, and what the benefit amount should
    be.

    By contrast, SSI is a welfare program composed of aged, blind, and
    disabled recipients with limited or no work histories.  Benefit
    eligibility and payment amounts for this population are determined by
    complex and often difficult to verify financial factors such as an
    individual's income, resource levels, and living arrangements.
    Individual financial circumstances may change often, requiring SSA to
    frequently reassess recipients' eligibility for and level of
    benefits.  Thus, the SSI program tends to be more difficult,
    labor-intensive, and time-consuming to administer than the OASI and
    DI programs.  These fundamental differences in SSA's programs require
    different management approaches for implementing the programs, as
    well as different policies and priorities to serve their diverse
    populations and ensure the accuracy of program payments.

       SSI IS A COMPLEX PROGRAM THAT
       HAS OFTEN BEEN AFFECTED BY
       EXTERNAL FORCES
    ---------------------------------------------------------- Chapter 1:4

    Since its inception, the SSI program has been difficult to administer
    because, similar to other means-tested programs, it relies on
    complicated criteria to determine initial and continuing eligibility,
    myriad policies and procedures for assessing recipients' often
    changing income and resource levels, and constant monitoring to
    ensure benefit amounts are adjusted to reflect these changes quickly
    and adequately.  Over the years, the SSI program has become even more
    complex as a result of policy and procedural changes often influenced
    by legislation and decisions issued by the courts.

    Over time, legislative changes have had the effect of liberalizing
    the SSI eligibility criteria on many occasions, and restricting them
    at other times.  Thus, SSA has been tasked with implementing
    ever-changing program policies and managing fluctuating recipient
    populations.  The Social Security Disability Benefits Reform Act of
    1984 is a primary example of a legislative change significantly
    affecting the SSI program.  This act expanded the general definition
    of disability for both children and adults.  Specifically, the act
    required new standards for judging the impact of mental impairments
    on eligibility.  It also required SSA to consider the combined
    effects of multiple impairments if no single impairment was
    sufficiently disabling to allow someone to qualify for benefits.
    Furthermore, the act allowed SSA to accept and consider nonmedical
    evidence provided, for example, by an applicant's family and friends
    when making the disability determination.  Finally, the act required
    SSA to obtain medical evidence from an individual's treating
    physician, if possible, before evaluating evidence from other
    sources.  This law greatly expanded access to disability benefits and
    contributed to increases in the number of younger, mentally disabled
    individuals on the SSI rolls.  In 1996, the Congress passed the
    Personal Responsibility and Work Opportunity Reconciliation Act,
    which made the SSI eligibility criteria for children and noncitizens
    more restrictive than it had been.  Subsequently, the Balanced Budget
    Act of 1997 restored a significant number of noncitizens' SSI
    benefits.  Thus, SSA has expended significant staff and
    administrative time dealing with the effects of these legislative
    changes.

    A major court decision also played a role in the transformation and
    increasing complexity of the SSI program.  For example, in 1990 the
    Supreme Court\6 held that SSA's disability determination process
    violated the law because it held children to a more restrictive
    standard than that applied to adults.  To comply with the decision,
    SSA developed an individualized functional assessment (IFA) for those
    children who did not qualify for disability on the basis of SSA's
    strict listings of impairments.  The IFA determined the extent to
    which the child's impairment limited his or her ability to act and
    behave in age-appropriate ways.  By expanding the SSI eligibility
    criteria, this decision contributed to a tripling in the number of
    children receiving SSI benefits between 1989 and 1996, from about
    300,000 to more than 1 million.  It also contributed to changes in
    the composition of childhood disability rolls as more awards were
    made to children who might not have met SSA's listing of impairments
    but qualified on the basis of the less restrictive Zebley criteria.
    In addition to increased workloads, these changes further complicated
    the disability determination process by requiring SSA to develop and
    implement a new set of regulations and procedures.  Moreover, the
    nature of these disabilities (generally, less severe mental and
    physical impairments) forced SSA to make more determinations on the
    basis of eligibility criteria that we reported to be subjective and
    difficult to consistently administer.

    With these legislative and court-driven SSI changes, program
    administration has become increasingly complicated.  SSA's own
    reviews have found that, over the years, the SSI program has become
    "encrusted" with a mass of complicating and sometimes contradictory
    legislation and court-mandated changes.  According to SSA, each law
    or court decision was designed to fix a specific program problem.
    Cumulatively, however, their effect was to make the program much more
    complex to administer and difficult for recipients to understand than
    was originally intended.

    --------------------
    \6 Sullivan v.  Zebley, 493 U.S.  521 (1990).

       OBJECTIVES, SCOPE, AND
       METHODOLOGY
    ---------------------------------------------------------- Chapter 1:5

    The objective of this review was to document the underlying "root"
    causes of long-standing SSI program problems.  To do our work, we
    conducted an extensive literature review of 200 studies on the SSI
    program conducted by GAO, SSA, congressional committees, and various
    other external groups.  Some of these studies dated back to the SSI
    program's inception.  We also conducted more than 100 in-depth
    interviews with SSA personnel at all levels of the organization to
    obtain their perspectives on the most significant problems in the SSI
    program, the "root" causes of those problems, and agency actions
    taken to address them.  We supplemented this information with
    analysis of program performance data related to SSI beneficiary
    groups, overpayments, payment accuracy rates, penalties, and so
    forth.

    Our review was conducted at SSA's headquarters in Baltimore and four
    SSA regions:  San Francisco, Dallas, Atlanta, and New York--regions
    that account for more than 50 percent of the SSI population.  Our
    interviews included senior executives and middle managers as well as
    numerous line staff.  We also visited four state DDSs located in the
    four regions noted as well as SSA's OHA and Office of Inspector
    General.  While we sometimes state the statistical results of our
    structured interviews, the results are not generalizable to all SSA
    employees and managers.  However, we believe that these interviews
    are useful indicators of the views of staff responsible for servicing
    SSI workloads.  Our work was conducted between October 1996 and
    February 1998 in accordance with generally accepted government
    auditing standards.

    This report is organized around the two underlying causes that we
    believe have had the most significant impact on SSI program
    performance and integrity:  SSA's organizational culture and its
    reactive management approach.  Thus, a discussion of SSA's
    organizational culture and its impact on the financial integrity of
    the SSI program is addressed in chapter 2.  Chapter 3 pertains to
    SSA's management approach and its impact on SSA's ability to provide
    adequate program direction.  In presenting our findings, we have
    linked each long-standing problem to its most related root cause.
    However, we are aware that to varying degrees, SSA's organizational
    culture and management approach often overlap and cut across several
    of these problems.  As a result, some combination of these two root
    causes may be present in each problem area.  In some instances, the
    examples we cite as evidence of organizational culture are also
    applicable to our discussion of SSA's management approach.  Our
    method of categorization served as a general framework for linking
    each problem area to its most likely root cause and for determining
    an appropriate course of action to better control program
    expenditures and protect program integrity.

    ORGANIZATIONAL CULTURE HAS
    PERPETUATED SEVERAL LONG-STANDING
    PROBLEMS AND AFFECTED THE
    FINANCIAL HEALTH OF THE SSI
    PROGRAM
    ============================================================ Chapter 2

    SSA's organizational culture has historically placed a greater value
    on quickly processing and paying SSI claims than on controlling
    program expenditures.  This culture has adversely affected SSA's
    ability to address several long-standing program problems and
    ultimately control program expenditures.  To a significant extent, an
    agency's culture emanates from and is shaped by top management
    officials who are charged with establishing the priorities,
    objectives, and performance measures that drive day-to-day program
    operations.  Thus, over time, what is regularly emphasized, measured,
    and rewarded by agency management becomes ingrained in the immediate
    workload priorities of line managers and field staff.  To the extent
    that agency priorities are not adequately balanced, serious
    vulnerabilities may arise and continue to hinder performance.  We
    reported in 1987 that SSA's agencywide operations had been heavily
    influenced by an organizational culture or value system that placed a
    greater emphasis on processing and paying claims than on controlling
    program costs or improving operational efficiency.\7 As evidence of
    this, we cited the results of our survey of a random sample of almost
    650 mid-level managers.  Over 67 percent of these managers noted that
    the number one factor emphasized by upper management when assessing
    their work was timeliness.

    More than a decade later, our current field work confirmed that
    little has changed, and SSA's organizational culture continues to
    pose a barrier to reducing SSI fraud, abuse, and mismanagement.  More
    specifically, our work shows that, to a great extent, SSI program
    vulnerabilities are attributable to an agency culture that has tended
    to view the SSI program in much the same way as SSA's title II
    programs--where emphasis is placed on quickly processing claims and
    making payments to individuals with an earned right to
    benefits--rather than as a welfare program that requires stronger
    income and asset verification policies.  Consequently, SSI program
    policies and internal controls do not adequately protect taxpayer
    dollars from being overspent or abused.  SSA's underlying culture has
    been most evident as it relates to three long-standing problem areas
    affecting SSI program performance:  (1) inadequate attention to
    verifying initial and continuing SSI eligibility, (2) lack of
    priority on recovering SSI overpayments, and (3) insufficient
    attention to addressing program fraud and abuse.

    --------------------
    \7 Social Security Administration:  Stable Leadership and Better
    Management Needed to Improve Effectiveness (GAO/HRD-87-39, Mar.  18,
    1987).

       INATTENTION TO VERIFYING
       RECIPIENTS' INITIAL AND
       CONTINUING SSI ELIGIBILITY HAS
       AFFECTED PROGRAM INTEGRITY
    ---------------------------------------------------------- Chapter 2:1

    When determining SSI eligibility, SSA relies heavily on applicants
    and recipients to self-report important information relating to their
    financial status and disabling condition.  Although SSA has
    procedures in place to verify this information, they are often
    untimely, incomplete, and subservient to the primary agency goal of
    quickly processing and paying claims.  Data provided to us by SSA's
    quality reviewers confirmed that the current system of self-reporting
    and inadequate verification of this information has been costly to
    the program.  According to SSA, 77 percent of all payment errors
    resulting in overpayments between fiscal year 1991 and 1995 were
    attributable to recipients' noncompliance with reporting
    requirements.  And statistics show that once an SSI overpayment
    occurs, SSA's success at recovering the overpayment is limited.
    Thus, effective initial and posteligibility verification policies are
    essential to avoiding or mitigating potential overpayment
    situations.\8

    Our prior work suggests that recipients do not always report required
    information when they should, and may not report it at all.  For
    example, in 1996, we reported that about 3,000 current and former
    prisoners in 13 county and local jails had been erroneously paid $5
    million in SSI benefits, mainly because recipients or their
    representative payees did not report the incarceration to SSA as
    required, and SSA had not arranged for localities to report such
    information.\9 In a report issued last year on SSI recipients
    admitted to nursing homes, we found that despite legislation
    requiring recipients and facilities to report such admissions,
    thousands of SSI recipients residing in nursing homes continued to
    receive full SSI benefits.\10 These erroneous payments occurred
    because recipients and nursing homes did not report this information
    and SSA lacked timely and complete automated admissions data.  We
    also found that some offices placed a much lower priority on
    investigating nursing home admissions information than on work
    responsibilities that are monitored by SSA management, such as
    processing claims.  SSA has estimated that overpayments to recipients
    in nursing homes may exceed $100 million annually.

    To verify that recipient financial information is correct, SSA
    generally relies on computer matching of data from other federal and
    state agencies, such as the Internal Revenue Service, the Department
    of Veterans Affairs, and state-maintained monthly earnings and
    unemployment benefits data.  In many instances, these matches allow
    SSA to detect information recipients fail to report.  However, SSA's
    data matches are not always the most effective means of verifying
    recipient financial status because the information is often quite old
    and sometimes incomplete.  In 1996, we estimated that direct on-line
    connections (as opposed to computer matches) between SSA's computers
    and databases maintained by state agencies-welfare benefits,
    unemployment insurance, and workers' compensation benefits could have
    prevented or more quickly detected $34 million in SSI overpayments in
    one 12-month period.\11

    In March 1998, we reported that SSA's computer matches for earned
    income rely on state data that are from 6 to 21 months old, allowing
    overpayments to accrue for this entire period before collection
    actions can begin.  We concluded that newly available Office of Child
    Support Enforcement (OCSE) databases maintained by SSA could prevent
    or more quickly detect about $300 million in annual SSI overpayments
    caused by unreported recipient income.\12 These databases include
    more timely state-reported information on newly hired employees, as
    well as the quarterly earnings reported for these individuals.  In
    the same report, we also concluded that opportunities existed for SSA
    to prevent almost $270 million in overpayments by obtaining more
    timely financial account information on SSI beneficiaries.  This
    could be accomplished if SSA moves to obtain access to a nationwide
    network that currently links all financial institutions.  Such
    information would help ensure that individuals whose bank accounts
    would make them ineligible for SSI do not gain eligibility.  On
    average, SSA collects only about 15 percent of outstanding SSI
    overpayments.  Thus, it is paramount that SSA move forward in
    obtaining and utilizing more timely and complete recipient financial
    information to prevent overpayments from occurring.  By doing so, SSA
    may reduce the likelihood of having to go through the often difficult
    and unsuccessful process of trying to recover overpaid SSI benefits.

    Our recent work confirmed that recipient self-reporting and SSA's
    ineffectiveness at verifying this information remain a major SSI
    program weakness.  During our visits to field offices, nearly 80
    percent of staff and managers interviewed noted that recipient
    nonreporting remains a serious problem in the SSI program.  In
    discussing how SSA could encourage individuals to better report
    important eligibility information, many staff believed SSA should
    require recipients to furnish additional documentation on their
    financial status, promote more frequent use of penalty provisions,
    and acquire more authority to suspend payments to those who
    chronically fail to report essential information.  Staff and managers
    were particularly concerned that SSA had not addressed long-standing
    living arrangement verification problems, despite many years of SSA
    quality reviews denoting this as an area prone to error and abuse.

    To determine SSI eligibility and benefit amounts, SSA staff apply a
    complex set of policies to document an individual's living
    arrangements and any additional support they may be receiving from
    others.  This process depends heavily on self-reporting by recipients
    of whether they live alone or with others; the relationships
    involved; the extent to which rents, food, utilities, and other
    household expenditures are shared; and exactly what portion of those
    expenses the individual pays.  In one field office we visited, staff
    identified a pattern of activity involving recipients who, shortly
    after becoming eligible for SSI benefits, claim that they have
    separated from their spouse and are living in separate residences.
    Staff suspected that these reported changes occurred as married
    recipients became aware that separate living arrangements would
    substantially increase their monthly SSI benefits.  They also
    suspected that several local attorneys were preparing "boiler plate"
    separation agreements to help these individuals qualify for higher
    benefits.  However, because of a lack of field representatives
    necessary to investigate these claims, only rarely were these cases
    closely reviewed or challenged.

    Finally, in addition to inadequate verification of recipients'
    financial eligibility, SSA has historically placed little priority on
    determining whether SSI recipients continue to remain medically
    eligible for benefits.  To determine medical eligibility, SSA must
    conduct continuing disability reviews (CDR).  SSA recently estimated
    that conducting SSI CDRs on the 1.9 million recipients due or overdue
    for a CDR would remove from the rolls about 5 percent of those
    individuals.  On the basis of this information, we estimated that
    these recipients would have received $481 million in federal SSI
    benefits.\13 However, since the program's inception, SSA conducted
    relatively few SSI CDRs until it was first mandated to do so by the
    Congress in 1994.  This legislation required SSA to review one-third
    of the beneficiaries who reached age 18 and at least 100,000
    additional beneficiaries annually for fiscal years 1996 to 1998.\14

    Subsequent legislation passed in 1996 required SSA to conduct
    additional CDRs for children who were likely to improve and low birth
    weight infants in their first year of life, as well as
    redeterminations for all SSI children beginning on their 18th
    birthday.\15 SSA estimates that about 600,000 cases will be added to
    its CDR workloads between fiscal years 1998 and 2000 to meet these
    requirements.  Agency management has attributed its past failure to
    conduct SSI CDRs to resource constraints and no legal requirement to
    do so.  SSA's inaction likely resulted in continuing benefit payments
    to ineligible recipients and hundreds of millions of dollars in
    unwarranted program costs since the program began.  However, SSA
    recently reported that during fiscal year 1997, it processed over
    690,000 CDRs, a 38-percent increase over 1996.  The agency expects to
    process 1.2 million CDRs in fiscal year 1998.

    In a briefing with SSA management, we conveyed our finding that the
    eligibility verification aspects of the SSI program have not been
    adequately emphasized.  SSA's Acting Principal Deputy Commissioner
    acknowledged that because of the rapidly rising workloads of prior
    years, SSA decided to emphasize and prioritize the expedient
    processing and payment of SSI claims rather than delay final
    decisions by requiring more thorough verification steps and risk
    hurting some recipients.  More recently, however, SSA has begun to
    take more decisive action to protect the financial integrity of the
    SSI program.  For example, SSA has started a program to identify SSI
    recipients in jail who should no longer receive benefits and is
    expanding its use of on-line state data to obtain more real-time
    applicant and recipient information.  In accordance with our
    recommendation, SSA also plans to give field offices on-line access
    to OCSE wage data, new-hire data, and unemployment insurance data
    beginning in March 1999.  This should allow field staff to better
    prevent SSI overpayments by identifying undisclosed earnings at the
    time of application.  SSA's fiscal year 1999 budget also asks for an
    additional $50 million to complete financial redeterminations for
    individuals who have been designated by SSA as having a high
    probability of being overpaid.\16 SSA also told us that it is
    continuing to study SSI living arrangement policies and may
    ultimately consider proposing legislative changes to reduce the
    complexity of the verification process and protect program dollars
    from being overpaid to recipients.  Finally, in its current strategic
    plan, SSA acknowledges that the needs of applicants and recipients
    have been the nearly singular focus of past strategic and business
    plans.  The plan now calls for a better balance between SSA's
    traditional approach to its programs and the need to control program
    costs.

    Despite SSA's planned and ongoing efforts, we continue to be
    concerned that, in many areas, progress has been limited.  For
    example, SSA's negotiations with states to obtain expanded on-line
    access to their databases are moving slowly, and the agency still
    does not adequately use on-line access as an overpayment detection
    and prevention tool.  In regard to SSI recipients residing in nursing
    homes, SSA plans to use a newly developed Health Care Financing
    Administration system to more effectively capture information on
    admissions to these and other facilities.  However, we reported last
    year that automated nursing home data were already available in all
    state medicaid agencies and could have been used by SSA in the
    interim to identify SSI recipients living in nursing homes within 1
    to 3 months of admission.\17 SSA's failure to use this information
    while waiting for the implementation of an alternative system has
    left the SSI program open to continued abuse and millions of dollars
    in potential overpayments.  Finally, despite SSA's plans to continue
    to study SSI living arrangement policies and problems, this costly
    program vulnerability remains unaddressed more than two decades after
    implementation of the program.

    --------------------
    \8 SSI overpayments include payments to individuals ineligible for
    the program as well as to those receiving higher benefit payments
    than their income and assets warrant.

    \9 Supplemental Security Income:  SSA Efforts Fall Short in
    Correcting Erroneous Payments to Prisoners (GAO/HEHS-96-152, Aug.
    30, 1996).

    \10 Supplemental Security Income:  Timely Data Could Prevent Millions
    in Overpayments to Nursing Home Residents (GAO/HEHS-97-62, June 3,
    1997).

    \11 Supplemental Security Income:  Administrative and Program Savings
    Possible by Directly Accessing State Data (GAO/HEHS-96-163, Aug.  29,
    1996).

    \12 Supplemental Security Income:  Opportunities Exist for Improving
    Payment Accuracy (GAO/HEHS-98-75, Mar.  27, 1998).

    \13 Supplemental Security Income:  SSA Is Taking Steps to Review
    Recipients' Disability Status (GAO/HEHS-97-17, Oct.  30, 1996).

    \14 Social Security Independence and Program Improvements Act of
    1994.

    \15 Personal Responsibility and Work Opportunity Reconciliation Act
    of 1996.

    \16 These redeterminations would be for nondisability factors of SSI
    eligibility.

    \17 GAO/HEHS-97-62, June 3, 1997.

       SSI OVERPAYMENT RECOVERIES HAVE
       RECEIVED INADEQUATE AGENCY
       ATTENTION
    ---------------------------------------------------------- Chapter 2:2

    In addition to problems associated with SSA's verification of
    important SSI eligibility information, SSA has not aggressively
    pursued the recovery of overpayments.  Thus, over time, SSA's
    recovery efforts have been outpaced by outstanding SSI debt, which is
    becoming an increasingly larger portion of all debt owed to the
    agency.  Between 1989 and 1997, outstanding SSI debt and annual
    overpayments more than doubled to about $2.6 billion.  Although
    overpayment recoveries also increased each year during this period,
    the gap between what is owed SSA and what is actually collected each
    year has continued to widen.

          INSUFFICIENT USE OF DEBT
          COLLECTION TOOLS
    -------------------------------------------------------- Chapter 2:2.1

    One reason overpayment recoveries remain low is that SSA has not
    adequately used the SSI overpayment recovery tools currently
    available to it.  For example, SSA only this year began using the tax
    refund offset (TRO) to recover SSI overpayments from former SSI
    recipients, despite having had the authority to do so since 1984.
    The TRO has proven effective in another welfare program--Food
    Stamps--for collecting delinquent debt.  In explaining why SSA did
    not act sooner to implement the TRO, agency officials told us that
    because the targeted population was generally poor, the expected
    recovery amounts--estimated at about $6 million for fiscal year
    1998--were relatively small compared with the total debt owed SSA.
    However, an official responsible for overseeing this initiative
    conceded that SSA has historically experienced little success
    recovering overpayments from former SSI recipients and, regardless of
    its dollar impact, the TRO represented one of the few tools available
    to SSA for increasing recoveries for this population.  He also agreed
    that sustained use of the TRO could deter recipients from
    misreporting eligibility information to SSA in the future.  So far
    this year, the TRO has far exceeded SSA's overpayment recovery
    estimates.  In fact, SSA recently testified that, in the first 4
    months of 1998, it had collected more than $23 million.

    Another reason SSI overpayment debt has increased is that SSA does
    not have, and has not adequately pursued authority to use more
    aggressive debt collection tools, including the ability to
    administratively intercept other federal payments recipients may
    receive, notify credit bureaus of an individuals' indebtedness, use
    private collection agencies, and charge interest on outstanding SSI
    debt.  At present, SSA lacks statutory authority to use these tools
    to recover SSI overpayments.  In 1995, we reported that welfare
    programs that used a broad range of collection tools, such as those
    listed, experienced better rates of overpayment recovery than
    programs that did not.\18 In a recent testimony, SSA management also
    acknowledged that such tools are valuable in recovering program
    overpayments from individuals who have left the SSI rolls.  Following
    a number of GAO briefings over the last year, and a recent testimony
    in which we noted SSA's continued reluctance to pursue more
    aggressive debt collection tools,\19 SSA announced that it is now
    seeking authority to recover overpayments of title II benefits made
    to former SSI recipients, as well as use credit bureaus, collection
    agencies, interest levies, and so forth to strengthen its collection
    efforts.

    To recover overpayments from current SSI beneficiaries, SSA relies
    primarily on withholding monthly SSI benefit payments.  Before 1984,
    SSA could withhold up to 100 percent of an overpaid individual's
    benefit amount.  However, pursuant to the Deficit Reduction Act of
    1984 (P.L.  98-369), SSA was limited to offsetting a maximum of 10
    percent of a recipients' total monthly income, which includes SSI
    payments.  Thus, SSA lost the discretion to withhold larger amounts,
    even for individuals who willfully and/or continually fail to report
    essential information.  SSA also lost a valuable means of encouraging
    timely recipient reporting of information.  In discussing the
    barriers to increased overpayment collections, headquarters officials
    told us that the 10-percent withholding ceiling has affected SSI
    collection efforts.  However, SSA has not sought a change in this
    cap, even for individuals who chronically fail to report important
    eligibility information or abuse the program.

    SSA also is not adequately utilizing overpayment penalties as a means
    of ensuring that recipients comply with reporting policies.  Field
    office personnel may impose penalties on recipients who fail to
    submit timely reports of events that affect their eligibility for, or
    the amount of, SSI payments.  Overpayment penalties range from $25 to
    $100.  SSA's own reviews have noted that overpayment penalties, if
    enforced by SSA, could serve as a deterrent to untimely recipient
    reporting.  However, the agency found that penalty provisions were
    almost universally ignored by field offices.  In a sample review,
    analysts concluded that no penalty was considered in about 50 percent
    of overpayment cases in which the individual had a history of failure
    to make timely reports of earnings or living arrangements, or both.

    During our visit to field offices, almost 80 percent of staff and
    managers interviewed told us that penalties are still rarely used in
    the field to encourage recipients to better report essential
    eligibility information.  When asked why penalties were rarely used,
    staff commonly complained that SSA management did not encourage their
    use.  Many others said that current penalty policies were unclear and
    too labor intensive to implement, and that dollar amounts were too
    low to change recipient behavior.  Our analysis of data from all 10
    of SSA's regions confirmed that penalties are still rarely levied.
    In one 12-month period, SSA detected about $1.2 billion in erroneous
    payments.  However, less than $80,000 in penalties was assessed by
    SSA, and only about $8,000 was actually collected.  These infrequent
    penalty assessments are a concern, considering that SSA's own reviews
    have found that, on average, 77 percent of all overpayments are
    attributable to recipient noncompliance with reporting requirements.

    --------------------
    \18 Welfare Benefits:  Potential to Recover Hundreds of Millions More
    in Overpayments (GAO/HEHS-95-111, June 20, 1995).

    \19 Supplemental Security Income:  Organizational Culture and
    Management Inattention Place Program at Continued Risk
    (GAO/T-HEHS-98-146, Apr.  21, 1998).

          UNRECOVERED SSI DEBT IS
          MOUNTING
    -------------------------------------------------------- Chapter 2:2.2

    Efforts to improve overpayment debt recoveries are particularly
    important because the gap between what is collected and what is owed
    the program is continuing to grow (see fig.  2.1).  SSA's data show
    that in fiscal year 1989, outstanding SSI debt and newly detected
    overpayments totaled $792 million.  During that year, SSA recovered
    about $165 million.  By fiscal year 1997, outstanding SSI debt and
    new overpayment detections grew to about $2.6 billion.  Of the total
    amount, SSI recovered $437 million.  Although annual overpayment
    recoveries have increased steadily, the amount of outstanding SSI
    debt has consistently outpaced SSA's collection efforts.
    Furthermore, as overpayment debt has grown, the amounts written off
    by SSA each year have also increased.  Write-offs include overpayment
    waivers and debt deemed uncollectible by SSA.  Policies governing the
    issuance of waivers take into account whether the recipient or SSA
    was at fault in creating the overpayment and the dollar amounts
    involved.  In addition to waivers, SSA may deem some debts
    uncollectible for numerous reasons, including the inability to locate
    an individual for a prolonged period.  Since 1989, SSI write-offs
    have totaled more than $1.8 billion.  This number includes $562
    million written off in 1997 alone (see fig.  2.2).  According to SSA,
    the 1997 write-offs included about $345 million in debt that had been
    carried on SSA's books for years and was determined to be not
    cost-effective to pursue.  Regardless of the reason, these write-offs
    represent overpaid program benefit dollars that will likely never be
    recovered.  More importantly, when these accumulated write-offs are
    added to the outstanding SSI debt after collections for 1997, the
    actual amount of unrecovered SSI debt since 1989 exceeds $3.4
    billion.

       Figure 2.1:  Gap Between SSI
       Overpayments and Recoveries
       Continues to Widen, Fiscal
       Years 1989-97

       (See figure in printed
       edition.)

    Source:  SSA's Office of Finance, Assessment, and Management.

       Figure 2.2:  Write-Offs of SSI
       Overpayment Debt Have
       Increased, Fiscal Years 1989-97

       (See figure in printed
       edition.)

    Source:  SSA's Office of Finance, Assessment, and Management.

       DESPITE RECENT AGENCY ACTIONS,
       SSI PROGRAM REMAINS VULNERABLE
       TO FRAUD AND ABUSE
    ---------------------------------------------------------- Chapter 2:3

    The SSI program remains vulnerable to abuse, despite agency
    initiatives to address it.  Shortly after SSA began administering SSI
    in 1974, a study group was commissioned to evaluate the program and
    recommend changes to improve effectiveness and fiscal accountability.
    The study group noted that a well-designed program with built-in
    integrity safeguards would hold opportunities and occurrences of
    fraud to a minimum.  However, they ultimately concluded that the SSI
    program was originally implemented without adequate attention to
    program integrity considerations and suffered from serious
    shortcomings in the areas of fraud detection, prevention, and
    prosecution.  Over the ensuing years, reports of program fraud and
    abuse have often centered on recipients' failure to report their
    financial status, the faking of disabilities, and fraudulent
    residence reporting.

    For example, we reported in 1995, that "middlemen" were facilitating
    fraudulent SSI claims while providing translation services to
    non-English-speaking individuals applying for SSI.\20 These
    individuals often coached claimants on appearing to be mentally
    disabled, used dishonest health care providers to submit false
    medical evidence to SSA, and provided false information on claimants'
    medical and family history.  The following year, we reported that
    between 1990 and 1994, approximately 3,500 SSI recipients admitted
    transferring ownership of resources such as cars, cash, houses, land,
    and other items valued at an estimated $74 million in order to
    qualify for benefits.\21 This number represents only resource
    transfers that recipients actually reported to SSA.  The SSI program
    is designed to help individuals who have limited resources meet basic
    needs.  Although these transfers are not prohibited under current
    law, using them to qualify for SSI benefits has become an abusive
    practice that raises serious questions about SSA's ability to protect
    taxpayer dollars from waste and abuse.  We estimated that for the
    cases mentioned, eliminating asset transfers would have saved $14.6
    million in program expenditures.  The Congressional Budget Office
    (CBO) has estimated that more than $20 million in additional savings
    could be realized through 2002 by implementing an asset transfer
    restriction.

    Although SSI represents less than 8 percent of SSA's total program
    expenditures, the prevalence of fraud in the program is significant.
    In 1997, SSA's OIG noted that the income and resource requirements
    associated with determining SSI eligibility created additional
    opportunities for fraud and abuse.  The OIG generally receives
    allegations of fraud directly from the general public, the Congress,
    other government agencies, SSA personnel, and through its hot line,
    which began operation in November 1996.  Through mid-July 1997, the
    hot line received 12,680 allegations of fraud.  When compared with
    SSA's other programs--OASI and DI--SSI fraud represented about 37
    percent of all allegations received and about 24 percent of the fraud
    convictions obtained.

    Since becoming an independent agency in 1995, SSA has begun to take
    more decisive action to address SSI program fraud and abuse.  For
    example, the number of OIG investigators has nearly tripled from 76
    to 227 headquarters and field agents, and in 1997, combatting fraud
    and abuse became a key agency goal.  Last year, SSA also created
    national and regional anti-fraud committees to better identify,
    track, and investigate patterns of fraudulent activity.  In addition,
    several OIG pilot investigations are also under way that are aimed at
    detecting fraud and abuse earlier in the SSI application process.
    One such pilot involves the creation of special units located in DDS
    offices in several states.  As a preventive measure, these units
    review disability applications, document evidence of fraudulent
    transactions and identify pervasive patterns of fraud.  According to
    SSA, this new emphasis on early prevention represents a major shift
    away from how the agency has traditionally dealt with fraud and
    abuse.  SSA also recently established procedures to levy civil
    monetary penalties against recipients and others who make false
    statements to obtain SSI benefits.  Following our briefings with
    SSA's Deputy Commissioner and our two testimonies over the last year
    that identified asset transfers as an area subject to abuse by
    recipients, SSA also recently submitted a proposal to the Congress
    aimed at preventing individuals from transferring assets in order to
    qualify for SSI benefits.\22 Finally, in its new annual performance
    plan, SSA has made a commitment to complete a comprehensive action
    plan to improve the management of the SSI program during fiscal year
    1998.  This step links to SSA's strategic goal of making its programs
    the "best in the business, with zero tolerance for fraud and abuse."

    It is too early to tell what immediate and long-term effects SSA's
    activities will have on preventing fraud and abuse in the SSI
    program.  However, many years of inadequate attention to program
    integrity issues has fostered a strong skepticism among both
    headquarters and field staff that fraud prevention is an agency
    priority.  In fact, SSA's own studies show that many staff believe
    the OIG does not adequately investigate fraud referrals or provide
    adequate feedback on the status of investigations.  Other staff noted
    that constant agency pressure to process more claims impeded the
    thorough verification of recipient-reported information and the
    development of fraud referrals.  SSA also found that staff were
    concerned that the agency had not developed office work-credit
    measures, rewards, and other incentives to encourage staff to devote
    more time to developing fraud cases--a process that often takes many
    hours.  SSA's Field Office Work Measurement System is used by
    management to determine what employees are working on, the volume of
    work completed, and how much time staff spend on particular
    activities.  SSA assigns numerical values to certain tasks, such as
    processing disability claims, that are based on the average time it
    takes to accomplish them.  For example, for an initial SSI claim for
    an aged person SSA determined that it should take about 3.24 hours.
    Any additional time spent verifying information or investigating
    suspected fraud for this claim would not receive credit.  SSA
    ultimately uses these data to estimate resource needs, assess
    component productivity, and justify budget and staffing levels.

    Our review of SSA's office work-credit system confirmed that adequate
    measures of the activities and time necessary to develop fraud
    referrals have not been developed.  Nor has SSA developed a means of
    capturing fraud activity data or recognizing staff for additional
    time spent developing fraud cases.  This weakness in the current
    work-credit system was noted by a speaker at SSA's annual Anti-Fraud
    Conference.  In a speech advocating a better balance between customer
    service and protecting the public trust, this field office manager
    voiced concern that staff have been sent the message that "timeliness
    and volume are the top priorities." As a result, few staff may be
    willing to devote significant time to more thorough claims
    verification because they fear production--cases processed and
    paid--will be negatively affected.  Thus, SSA's new anti-fraud
    activities and its current work-credit system may be working against
    each other.

    --------------------
    \20 Supplemental Security Income:  Disability Program Vulnerable to
    Applicant Fraud When Middlemen Are Used (GAO/HEHS-95-116, Aug.  31,
    1995).

    \21 Supplemental Security Income:  Some Recipients Transfer Valuable
    Resources to Qualify for Benefits (GAO/HEHS-96-79, Apr.  30, 1996).

    \22 This draft bill is entitled the Supplemental Security Income
    Program Integrity Act of 1998 and was submitted to the Congress on
    May 4, 1998.

    SSA'S MANAGEMENT APPROACH HAS
    HINDERED ADEQUATE PROGRAM
    DIRECTION
    ============================================================ Chapter 3

    In addition to long-standing problems attributable to SSA's
    organizational culture, our work suggests that SSA's management of
    the program has often led to untimely and flawed SSI program policies
    and inadequate program direction.  Proactive program management
    requires a willingness on the part of an agency to identify and
    decisively address problems before they reach crisis levels.  Where
    internal operational remedies are insufficient to address a
    particular program weakness, the agency should then suggest and
    sponsor legislative proposals for addressing underlying policy
    weaknesses.  Proactive management also requires a willingness to
    identify short- and long-term program priorities and goals and to
    develop a clearly defined plan for meeting those goals.  But SSI
    program direction and problem resolution have been hindered by SSA's
    continued reluctance to take a leadership role in SSI policy
    development before major program crises occur and the subsequent
    tendency to react to these crises through a series of often ad hoc
    and piecemeal initiatives.  Program direction has been further
    impaired by a strategic planning process that has not sufficiently
    focused on the specific characteristics and needs of the SSI program
    and its recipients.

       INSUFFICIENT AGENCY INVOLVEMENT
       IN SSI POLICY DEVELOPMENT
    ---------------------------------------------------------- Chapter 3:1

    As the nation's SSI program expert, SSA is uniquely positioned to
    assess the program impacts of trends in the SSI population.  It is
    also in the best position to initiate internal policy "fixes" to
    address specific problems.  If internal revisions would not be
    effective, SSA is best qualified to identify areas where new
    legislation is needed to address program weaknesses and to assist
    policymakers in exploring and developing legislative options for
    change.  However, SSA has not been sufficiently aggressive in this
    regard.  Instead, SSA's approach to policy development has often been
    reactive in nature, resulting in several missed opportunities to
    address flawed operational policies and to play a key role with
    policymakers in addressing critical issues affecting SSI program
    performance and integrity.  Recent examples of SSA's management
    approach include its reluctance to develop policy options to address
    problems associated with assessing the SSI eligibility of children
    and substance abusers, helping SSI recipients enter the workforce,
    and determining recipient living arrangements.  SSA management has
    acknowledged the need to take a more proactive policy development
    role, and in the last few years has initiated several reorganizations
    of its policy component to strengthen its capacity.  In fact, SSA is
    currently restructuring its research and policy component in a way
    that it believes will facilitate a stronger focus on SSI program
    vulnerabilities and address our concerns in this area.  In 1997, SSA
    also made conducting effective policy development, research, and
    program evaluation a key goal of its strategic plan.  However, SSA
    only recently developed and submitted its first significant package
    of SSI policy proposals--draft legislation entitled the "Supplemental
    Security Income Integrity Act of 1998"--to the Congress.

    In 1984, a Congressional Panel on Social Security noted that it was
    SSA's responsibility to contribute to policy-making with advice,
    information, expert analysis, and the kind of judgment that results
    from the experience of program operations.  However, the panel
    concluded that SSA's policy-making had often taken place in an
    atmosphere of crisis and improvisation rather than as part of a
    comprehensive strategy for addressing SSA's major program challenges.
    In 1995, we also criticized SSA for not taking a more active role in
    analyzing and suggesting policy options for its programs.\23 More
    specifically, in monitoring SSA's transition from a component of the
    Department of Health and Human Services to a separate and independent
    agency, we noted that SSA needed to take a more active role in
    addressing its major program challenges, including those related to
    its SSI caseloads.  In 1997, SSA's Advisory Board issued a report
    with similar conclusions.  The board noted that SSA should take a
    leadership role in the initiation of major policy changes rather than
    continue its pattern of reacting to short-term crises.  The board
    also found that SSA has had an overly cautious attitude toward
    initiating the analysis of controversial policy issues.  Their report
    concluded that improving program leadership would require SSA to
    revise its long-standing tendency to focus on operational issues and
    paying benefits to recipients at the expense of much needed program
    policy and research activities.

    As discussed in chapter 1, between 1984 and 1991, legislative changes
    and a major court decision greatly expanded the SSI eligibility
    criteria for children.  Rapid growth in the number of children
    receiving SSI disability payments, questions about SSA's ability to
    adjudicate claims consistently, and allegations that some parents
    were coaching their children to fake mental impairments to qualify
    for benefits, elevated public and congressional concern that the
    program was being abused.  In 1996, the Congress passed welfare
    reform legislation, which tightened SSI eligibility for children and
    restricted eligibility to those with the most severe impairments.  In
    this example, SSA possessed several years of program data documenting
    explosive growth in childhood disability caseloads, changes in the
    types of impairments qualifying for benefits, and the impacts of
    legislative and court-mandated program changes.  However, the agency
    failed to take a leadership role in developing and communicating this
    information to policymakers.  Nor did SSA develop formal proposals
    for addressing identified weaknesses in the childhood eligibility
    criteria, despite the fact that SSA had information that eligibility
    guidelines--in particular, the IFA--for determining the severity of
    childhood mental and behavioral impairments, were difficult to
    interpret, unclear, and too subjective.  At a much earlier time, this
    information could have been shared with the Congress for its
    consideration in reassessing whether SSI was meeting the needs of the
    most severely disabled children.

    SSA's reluctance to take a more proactive policy development role was
    also evident in regard to the recent debate surrounding SSI
    eligibility for drug addicts and alcoholics (DA&A).  In prior work,
    we reported that DA&A caseloads had increased more than 150 percent
    between 1989 and 1994.  We also raised serious questions about SSA's
    payment controls and its ability to prevent recipients from
    purchasing drugs and alcohol with SSI benefit payments.  Despite
    congressional concern and growing media criticism surrounding this
    issue, SSA did not take aggressive action to revise operational
    polices that were subject to abuse by recipients, or suggest
    legislative options for change.  SSA also failed to develop adequate
    data on the reasons for growth in the DA&A caseloads, the number of
    substance abusers actually in treatment, and the percentage of
    individuals who had left the rolls as a result of treatment and
    rehabilitation.  More importantly, however, SSA did not adequately
    share the information it did have with the Congress to assist it in
    addressing identified problems.  Thus, program abuses continued
    longer than they should have and the Congress ultimately acted on its
    own to tighten the eligibility criteria in this area.

    Our work has also shown that SSA has not provided adequate leadership
    in regard to helping recipients return to work and promoting economic
    independence.  Thus, few recipients leave the SSI rolls.  In several
    reports and testimonies issued over the last several years, we have
    faulted SSA's administration of SSI work incentives,\24 and
    documented the need for a comprehensive return-to-work strategy that
    includes earlier intervention, return-to-work assistance, and changes
    in the structure of cash and health benefits to encourage work.\25 We
    have also documented SSA's reluctance to play a leadership role in
    devising a return-to-work plan.  SSA management told us that it is
    only one player among many in the complex VR process, and that it
    does not have the ability to develop a comprehensive strategy on its
    own.  However, in its strategic plan, SSA has now pledged to pursue
    the objective of helping people return to work.  As a first step, SSA
    has developed a proposal, currently under consideration by the
    Congress, that would expand recipients' choices of VR providers.  In
    this instance, recipients would receive a "ticket" (similar to a
    voucher), which they could use to obtain services from public or
    private VR providers of their choice.  Although all pertinent players
    should be involved in formulating a comprehensive VR strategy, we
    continue to believe SSA has the fiduciary responsibility and is the
    appropriate agency to take the lead in ensuring that returning to
    work receives much greater emphasis.

    A final example of SSA's reluctance to address important program
    policy issues involves the policies and procedures SSA uses to
    determine recipient living arrangements and in-kind support and
    maintenance.  As discussed previously, when determining living
    arrangements, claims processors are required to apply a complex set
    of policies designed to document an individual's living situation and
    any additional support they may be receiving from others.  These
    numerous rules and polices have made living arrangement
    determinations one of the most complex and error-prone aspects of the
    SSI program, and a major source of SSI overpayments.  During our
    review, staff and managers told us that living arrangement policies
    needed reassessment and change.  SSA quality reviewers have also
    consistently identified living arrangement calculations as a major
    source of benefit payment errors.  During our review, we identified
    several internal and external studies of SSI living arrangement
    issues conducted over many years.  Some of these studies recommended
    ways to simplify the process by eliminating many complex calculations
    and thereby making it less susceptible to manipulation by recipients.
    Others contained recommendations for making the SSI program less
    costly to taxpayers by requiring that benefit calculations be subject
    to maximum family caps or economies of scale or both when two or more
    recipients reside in the same household.  In 1989, SSA's OIG reported
    that a more simplified process that applied an economies-of-scale
    rationale to all SSI recipients living with another person would
    result in fewer decision errors and reduce annual overpayments by
    almost $80 million.  The OIG also concluded that such a change would
    require legislative action.  Despite these studies, and the potential
    cost savings associated with addressing this issue, we could find no
    evidence that SSA has ever acted on the recommendations or submitted
    proposals for changing laws governing living arrangement policies.

    --------------------
    \23 Social Security Administration:  Leadership Challenges Accompany
    Transition to an Independent Agency (GAO/HEHS-95-59, Feb.  15, 1995).

    \24 PASS Program:  SSA Work Incentive for Disabled Beneficiaries
    Poorly Managed (GAO/HEHS-96-51, Feb.  28, 1996).  SSA's plan for
    achieving self-support (PASS) program allows SSI recipients to
    exclude income and resources from benefit calculations that otherwise
    would result in a reduction in SSI benefits, as long as the assets
    are used to pay expenses associated with reaching employment goals.

    \25 Social Security:  Disability Programs Lag in Promoting Return to
    Work (GAO/HEHS-97-46, Mar.  17, 1997) and Social Security Disability:
    Improving Return-to-Work Outcomes Important, but Trade-Offs and
    Challenges Exist (GAO/T-HEHS-97-186, July 23, 1997).

       AGENCY PLANNING EFFORTS DO NOT
       PROVIDE ADEQUATE SSI PROGRAM
       DIRECTION
    ---------------------------------------------------------- Chapter 3:2

    Our work has shown that SSI program direction has suffered as a
    result of SSA's failure to develop program-specific goals,
    priorities, and associated plans for addressing program weaknesses.
    In this report, we have discussed a number of long-standing problems
    that the SSI program continues to experience.  The continuation of
    these problems demonstrates SSA's inability to focus agency attention
    on its most significant program challenges and ensure that corrective
    actions are carried out and sustained over time.  To a significant
    degree, this may be due to SSA's strategic planning efforts, which
    generally involve agencywide goals and concerns, with no programmatic
    focus.  Thus, SSA still lacks a plan that lays out the SSI program
    areas most in need of attention in order to ensure effective service
    to the public and control program expenditures, both of which are
    critical to the Congress, oversight entities, and SSA's employees.
    Typically, organizations rely on their planning processes to document
    long- and short-term programmatic priorities.  The planning process
    also facilitates organizational agreement as to where efforts will be
    focused, what resources (both personnel and budgetary) will be
    devoted to initiatives, what the time frames for action will be, and
    how managers will be held accountable for meeting the stated
    objectives of each effort.  If the planning process fails to provide
    adequate management direction for a program, the organization tends
    to take ad hoc measures to address program problems when they become
    critical.

    In 1987, we noted that because of SSA's passivity in the area of
    program planning, it (1) lacked a top management focus on surfacing
    important program and operational issues, (2) was largely reactive to
    external pressure from the Congress and the courts to improve its
    programs, and (3) often addressed program challenges in an
    uncoordinated or inefficient manner.  SSA developed its first
    agencywide strategic plan in 1988 and then significantly revised it
    in 1991.  As required by the Results Act, SSA developed and submitted
    its current strategic plan in 1997.  This plan outlines SSA's
    strategic goals and objectives for the next 5 years.  As also
    required by the Results Act, SSA recently published its fiscal year
    1999 performance plan.  This plan provides more detailed information
    on how SSA intends to achieve its goals and the measures it will use
    to hold itself accountable over the next year.  Together, these two
    documents chart SSA's future course.

    In reviewing SSA's strategic and performance plans, we found that the
    manner in which SSA has framed them may undermine SSA's ability to
    address its most significant program vulnerabilities.  In particular,
    SSA's plans still do not adequately address the specific needs and
    problems of the SSI program, as well as the unique characteristics of
    its recipient population.  Instead, SSA's approach to planning has
    remained at the agencywide level, resulting in general goals and
    objectives, for SSA's three major programs.  Although macro-level
    goals and objectives are essential to SSA's operations, the absence
    of an SSI-specific strategy and the fact that few goals, initiatives,
    and performance measures are targeted to the program have impeded the
    establishment of clear program-specific priorities.  For example, we
    designated SSI a high-risk program primarily because of the magnitude
    of SSI overpayments.  Despite noting that SSA faces considerable SSI
    program challenges, the current strategic plan and annual performance
    plan contain few specifics as to how SSA intends to reduce the more
    than $1 billion in overpayments the program incurs annually.

    Furthermore, despite SSA's acknowledgement that SSI overpayments are
    difficult to recover and are becoming an increasingly greater portion
    of outstanding debt owed to the agency, SSA's plans do not include
    future SSI overpayment recovery targets or other measures to gauge
    whether debt collection rates are increasing or decreasing for this
    program.  Instead, SSA's current plans call for increasing debt
    collection agencywide by a total of 7 percent annually through 2002.
    Using this aggregate measure, however, could mask a worsening in
    future SSI debt collection levels if they were offset by slightly
    increased debt collections in the much larger OASI program.
    Consequently, SSA could meet its goal of increasing debt collection
    agencywide without establishing new initiatives to address SSI debt
    collection or actually recovering more SSI overpayments.  In
    addition, SSA has also acknowledged that the SSI program is highly
    susceptible to fraud and abuse.  However, SSA's plans contain no
    measures or goals specifically targeted to SSI fraud prevention and
    detection, such as the number of SSI fraud referrals received, cases
    developed, convictions obtained, or penalties levied.  Without these
    elements, it may be difficult for SSA to determine the true extent of
    fraud and abuse in the SSI program and the impact its new fraud
    prevention initiatives will ultimately have on the program.  Although
    agencies may appropriately choose to aggregate such data in order to
    monitor agencywide progress, long-standing weaknesses in the SSI
    program argue for more closely monitoring debt collection and
    anti-fraud activities on a program-specific basis.

    Without a comprehensive strategy or plan for addressing specific SSI
    program problems, it is uncertain whether SSA will focus adequately
    on those areas that put SSI at the greatest risk or that corrective
    actions will be sustained over time.  In its new annual performance
    plan, SSA has committed to developing a comprehensive SSI action plan
    in fiscal year 1998.  However, such a plan has not yet been
    completed, so it is still unclear whether SSA will focus adequately
    on its most significant SSI challenges.  In many areas, substantive
    program improvement may depend on the degree to which SSA succeeds in
    separately identifying SSI program needs, goals, and performance
    measures from those of its other programs, and targeting its efforts
    to the specific long-standing SSI problems discussed in this report.

    CONCLUSIONS, RECOMMENDATIONS, AND
    AGENCY COMMENTS AND OUR EVALUATION
    ============================================================ Chapter 4

    After more than 20 years of operation, the SSI program still faces
    significant problems.  To a large extent, these long-standing
    problems and SSA's inability to address them are attributable to an
    ingrained organizational culture that has historically placed a
    greater value on quickly processing and paying SSI claims than on
    controlling program costs, and a management approach that has been
    reluctant to address SSI program problems requiring long-term
    solutions and/or legislative change.  Together, these two underlying
    themes have allowed long-standing SSI program problems to continue
    and have contributed to the growth in SSI overpayments and
    outstanding debt.

    As noted in chapters 2 and 3, SSA has not always struck an adequate
    balance between meeting the needs of program recipients and fiscal
    accountability for its programs.  Often SSA's actions to address SSI
    program weaknesses have been ad hoc and crisis-driven, rather than
    part of a comprehensive strategy for improving program performance in
    the long term.  Thus, for many years, billions of program dollars
    have been erroneously paid to ineligible individuals, and SSA has not
    always dealt proactively with its most pressing program problems.  In
    its most recent strategic plan, SSA acknowledges the role of
    management leadership in shaping SSA's programs and the need to
    rebalance its program priorities in a way that improves
    accountability.  Significantly revising SSA's underlying
    organizational culture and management approach will likely take many
    years of concerted effort at the highest levels of the agency.
    However, we believe such a change is important to restoring public
    confidence in a program that provides critical assistance to so many
    needy, aged, and disabled recipients.

    More specifically, to address the issue of SSA's underlying culture
    and its effect on the financial health of the SSI program, sustained
    emphasis should be placed on reassessing SSA's traditional program
    priorities and better controlling program expenditures.  This will
    require SSA to revise and strengthen its approach to verifying SSI
    eligibility, deterring and recovering SSI overpayments, and
    combatting program fraud and abuse.  At present, many of the
    difficulties experienced by the SSI program are the result of more
    than 20 years of inattention to payment controls and SSA management's
    failure to make them a significant workload priority.  As a result,
    financial verification and program integrity issues receive
    inadequate emphasis, and continued abuse of the program by recipients
    often goes unchallenged by field staff.  A significant step in
    addressing SSA's prevailing culture is management's acknowledgement
    in its strategic plan that a rebalancing of SSI program priorities is
    overdue and in recent agency-sponsored proposals to address SSI
    program integrity issues.  However, SSA's management must be willing
    to direct change by providing sustained programmatic leadership,
    enhancing its commitment to the verification aspects of claims
    processing, implementing more stringent payment controls and debt
    collection tools, holding staff and managers accountable for
    protecting program funds, and finding better ways to reward those who
    do so.  If successful, SSA's actions should serve to reduce SSI
    overpayments, improve the financial integrity of the program, and
    ultimately reshape SSA's prevailing culture and value system.

    Regarding SSA's management approach, our work shows that SSA needs to
    demonstrate a greater willingness to identify and actively address
    emerging issues, and to provide a longer-term vision for the SSI
    program through its policy development and strategic planning
    activities.  As the acknowledged expert on the SSI program, SSA
    possesses myriad performance data and more than two decades of
    experience serving this often changing population.  Thus, the agency
    is in a unique position to lead and inform public debate on the range
    of issues affecting program performance and to establish an
    agencywide program vision.  SSA is also in the best position to offer
    long-term policy solutions for its most significant management and
    operational challenges before they reach crisis levels.  However, our
    work suggests that SSA has not yet maximized its research and policy
    development role, nor has it developed adequate SSI program plans to
    serve as a blueprint for managing the program more strategically,
    focusing long-term program priorities and defining specific program
    goals.

    In implementing the Results Act, SSA recently committed to developing
    an SSI action plan in fiscal year 1998.  To be effective, this plan
    should include a carefully designed set of initiatives aimed at
    addressing the long-standing problems affecting SSI program
    performance as well as specific measures to evaluate progress and
    hold the agency accountable.  Without such a plan, SSA risks
    continuing the policies and procedures that have allowed SSI
    overpayments to grow and perpetuating its often piecemeal approach to
    addressing program problems.  It also may forgo a valuable
    opportunity to communicate to its employees, the Congress, and other
    oversight entities its commitment to operating a more efficient and
    fiscally responsible program.

       RECOMMENDATIONS TO THE
       COMMISSIONER OF SOCIAL SECURITY
    ---------------------------------------------------------- Chapter 4:1

    Revising SSA's organizational culture will likely take several years
    of sustained effort at the highest levels of the agency.  To
    facilitate such a change, we recommend that the Commissioner of
    Social Security take the following actions:

      -- Enhance SSA's ability to verify applicant- and
         recipient-reported eligibility information and deter
         overpayments by accelerating efforts to identify more timely and
         complete sources for verifying SSI financial eligibility
         information.

      -- Sustain efforts to obtain and implement additional SSI
         overpayment deterrence and debt collection tools commonly
         available to other means tested programs.  These include using
         credit bureau reporting, collection agencies, intercepts of
         other state and federal benefit payments, and interest levies to
         recover more SSI debt.

      -- For recipients who chronically and willfully abuse SSI reporting
         requirements, seek legislative authority to withhold higher
         amounts than the current 10-percent maximum.

      -- Reassess current policies for imposing penalties on recipients
         who do not report important eligibility information.  This may
         include examining whether current penalty usage is sufficient to
         deter recipient nonreporting and removing any external or
         agency-created obstacles to using penalties.

      -- Reevaluate SSA's field office work-credit and incentive
         structure at all levels of the agency and make appropriate
         revisions to encourage better verification of recipient
         information and greater staff attention to fraud prevention and
         detection.  For improved accountability, line staff and middle
         management expectations, as well as senior executive contracts,
         should include specific requirements and performance measures in
         this area.

    To facilitate a change in SSA's management approach and improve SSI
    program direction, we recommend that the Commissioner of Social
    Security take the following actions:

      -- Better utilize SSA's policy development component to address SSI
         program policies that, for many years, have placed the program
         at risk of fraud, waste, and mismanagement.  This would include,
         but not be limited to, the development and advancement of
         legislative proposals aimed at simplifying complex SSI living
         arrangement and in-kind support and maintenance policies and
         continuing SSA's sponsorship of legislation restricting the
         transfer of valuable assets and resources to qualify for SSI
         benefits.

      -- Move forward in developing an SSI-focused strategy or plan with
         clearly defined priorities, goals, and performance measures to
         gauge SSA's progress in addressing its most significant SSI
         program challenges.  This document should be consistent with the
         Results Act and include specific initiatives, goals, and
         performance measures aimed at addressing long-standing SSI
         program problems and facilitating a change in SSA's
         organizational culture and management approach to the SSI
         program.

       AGENCY COMMENTS AND OUR
       EVALUATION
    ---------------------------------------------------------- Chapter 4:2

    In providing comments on this report, SSA agreed that the SSI program
    faces significant challenges.  However, the agency disagreed with our
    conclusion that it has historically placed a greater emphasis on
    processing and paying SSI claims than on controlling program
    expenditures.  SSA was also concerned that the draft report did not
    adequately acknowledge a number of initiatives it has undertaken to
    improve the financial integrity of the SSI program.  Accordingly,
    SSA's comments include a discussion of several key initiatives.
    Finally, SSA either fully or partially concurred with five of our
    seven recommendations.  SSA did not agree with our recommendation
    that it should seek legislative authority to withhold higher benefit
    amounts than the current 10-percent limit from individuals who
    chronically and willfully abuse reporting requirements.  SSA also
    disagreed with our recommendation that it reassess current penalty
    provisions for recipient nonreporting and remove any barriers to
    their use.  According to SSA, its newly submitted administrative
    proposal requesting authority to impose a period of ineligibility for
    individuals who provide false information to the agency is a more
    effective approach than reassessing current penalty provisions.  SSA
    agreed that its current field office work-credit and incentive
    structure should be reassessed to better ensure that payment accuracy
    and fraud prevention receive adequate staff attention.  However, the
    agency was concerned that incorporating specific requirements and
    performance measures for collections and fraud prevention into
    managers' performance plans could be misperceived both within and
    outside the organization.

    In regard to SSA's disagreement with our conclusion that it has
    historically placed inadequate emphasis on controlling program
    expenditures, we believe our audit work was sufficient to reach such
    a conclusion.  Our review involved an extensive analysis of 200
    studies of the SSI program dating back to its inception, more than
    100 interviews with staff and managers at all levels of the agency,
    and an assessment of performance data encompassing nearly a decade of
    program operations.  Throughout this report, we have also provided
    numerous examples drawn from this evidence to demonstrate how SSA's
    focus on quickly processing and paying SSI claims has allowed
    long-standing problems to continue and contributed to a program
    environment in which program policies and internal controls have not
    adequately protected taxpayer dollars from being overspent or abused.
    In interviews with us and in a recent testimony, SSA's Principal
    Deputy Commissioner also acknowledged that, because of the rapidly
    rising workloads of prior years, SSA made a conscious decision to
    prioritize expedited claims processing over instituting additional
    steps to better ensure payment accuracy and verify benefit
    eligibility.  Thus, we believe there is ample evidence to support our
    conclusion that SSI claims processing has historically received
    greater management emphasis.  However, this report also acknowledges
    the recent steps SSA has begun to take to address its most
    significant program challenges, and in the future, strike a better
    balance between meeting the needs of SSI recipients and protecting
    the financial integrity of the program.

    We also disagree with SSA's concern that we have not adequately
    recognized its initiatives to address long-standing SSI program
    vulnerabilities.  Although our primary audit work was conducted
    through February 1998, we frequently updated program performance data
    and the status of SSA's initiatives as information was provided to us
    by the agency.  To the extent that SSA's initiatives were either in
    the planning stages, partially initiated, or fully operational, we
    have fairly characterized them in this report.  We recognize that
    since the SSI program was designated a high-risk area by GAO, SSA has
    begun numerous initiatives to address the problems discussed here.
    We will continue to monitor SSA's progress in this area and relevant
    program performance data to determine whether its efforts to address
    identified SSI program vulnerabilities are successful.

    In regard to SSA's response to our specific recommendations, we
    continue to believe SSA should seek legislative authority to recover
    larger amounts than the current 10-percent limit from overpaid
    recipients who chronically fail to report important eligibility
    information.  We believe that providing field staff with the
    discretion to recover larger amounts from overpaid recipients who
    regularly fail to report information relevant to their disability or
    financial status will provide SSA with an additional deterrent
    against future instances of nonreporting.  Statistics also show that
    SSA collects only about 15 percent of overpaid benefits.  For those
    recipients who leave the rolls because they become employed or die,
    recovery becomes even less likely.  SSA's 1997 write-off of $562
    million in outstanding debt provides a clear example of how
    overpayments that are carried on SSA's books for many years become
    extremely difficult to recover.  Increasing the 10-percent limit
    should improve SSA's debt collection efforts by allowing it to more
    quickly recover a greater portion of overpaid benefits from
    individuals who abuse program requirements before leaving the SSI
    rolls.  However, it should be noted that our recommendation is
    designed to address chronic non-reporting by recipients.  For the
    majority of SSI recipients, we continue to believe that field staff
    should have the discretion to calculate repayment amounts for
    overpayments on the basis of an individual's ability to pay, rather
    than on a specified percentage of his or her monthly benefit payment
    or a specified dollar amount as determined by law.

    We have similar concerns about SSA's statement that a review of
    current overpayment penalty policies is unnecessary, despite the
    infrequent use of penalties and field staff complaints that the
    process is administratively burdensome.  By failing to act on this
    issue, SSA is forgoing a valuable opportunity to both demonstrate its
    commitment to deterring future instances of recipient nonreporting
    and to internally address agency policies that may be ineffective or
    difficult for staff to implement.  In its comments, SSA contends that
    its current legislative proposal seeking authority to suspend the
    benefits of individuals who knowingly fail to report important
    eligibility information renders our recommendation to reassess its
    penalty process unnecessary.  While we do not dispute the value of
    SSA's proposal, it is unclear whether such authority will ultimately
    be granted, and we continue to believe that improving SSA's existing
    penalty process to allow staff to quickly sanction individuals who
    regularly fail to comply with program reporting requirements will
    provide SSA with a deterrent against future overpayments.  In short,
    SSA's overpayment penalty process was intended to be an important
    internal control mechanism that should be fully utilized by the
    agency.  If SSA's legislative proposal is enacted into law, field
    staff will have another valuable tool, in addition to penalties, to
    control SSI payments.

    Finally, we believe SSA's decision to reevaluate its current field
    office work-credit and incentive system represents a positive step
    toward rebalancing SSI program priorities.  However, we do not agree
    with SSA's objection to developing specific performance measures to
    hold managers accountable for thoroughly verifying recipient
    information and combatting program fraud and abuse.  If properly
    designed and managed, these measures would provide much-needed
    incentives to encourage staff to devote more time to program
    integrity issues while servicing their daily workloads.  Such
    performance measures would also further demonstrate to field staff
    SSA management's commitment to protecting SSI benefits from being
    overpaid.  The full text of SSA's comments and our response are
    included in appendix II.

    SSA ORGANIZATIONAL CHART
    =========================================================== Appendix I

       (See figure in printed
       edition.)

       (See figure in printed
       edition.)

    Source:  SSA, 1998.

    (See figure in printed edition.)Appendix II
    COMMENTS FROM THE SOCIAL SECURITY
    ADMINISTRATION AND OUR EVALUATION
    =========================================================== Appendix I

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    (See figure in printed edition.)

    The following are GAO's comments on the Social Security
    Administration's letter dated July 24, 1998.

       GAO COMMENTS
    --------------------------------------------------------- Appendix I:1

    1.  SSA disagreed with our conclusion that it has historically
    emphasized processing and paying SSI claims over controlling program
    expenditures.  SSA was also concerned that we did not accurately
    recognize initiatives it has taken to address SSI program integrity
    issues.  In regard to SSA's first point, we believe that the evidence
    presented in this report supports our conclusion.  Our review
    involved an extensive analysis of 200 internal and external studies
    of the SSI program dating back to its inception, more than 100
    interviews of staff and managers at all levels of the agency, and an
    assessment of performance data encompassing nearly a decade of
    program operations.  Throughout this report we have also provided
    numerous examples of how SSA's historical emphasis on quickly
    processing and paying SSI claims has led to internal control
    weaknesses, overpayments to ineligible recipients, and has
    contributed to a program environment in which operating policies have
    not adequately protected taxpayer dollars from fraud and abuse.  We
    also disagree with SSA's claim that the draft report does not
    adequately reflect the initiatives SSA has recently undertaken to
    address long-standing SSI program vulnerabilities.  We believe the
    report fairly characterizes SSA's initiatives and accurately portrays
    their implementation status.

    2.  As noted above, we believe SSA's initiatives to control
    overpayments have been characterized fairly and accurately in this
    report.  In regard to SSA's efforts to better verify recipients'
    financial information by accessing the OCSE database, we do not fully
    agree with SSA's characterization that corrective actions were
    already under way before we made our recommendations.  Our March 1998
    report recommended that in addition to SSA's plans to use the OCSE
    database to recover overpaid SSI benefits, SSA should also develop
    automated field office interfaces to prevent overpayments by
    identifying undisclosed earnings at the time of application.\26 At
    the time of our review, SSA had not begun developing these interfaces
    and did not appear to have any concrete plans to do so.  However, on
    the basis of information received from SSA in July 1998, we have
    revised our report to note that, in accordance with our
    recommendation, SSA plans to provide such interfaces by March 1999.

    3.  The HCFA example was intended to illustrate SSA's historical
    reluctance to take a more proactive approach to overpayment detection
    and recoveries.  Consistent with our prior recommendation, we
    continue to believe that SSA should have taken immediate action to
    pursue interim agreements with state Medicaid agencies to obtain
    nursing home admissions data.  We also continue to believe that SSA's
    decision to wait for an alternative system when other data sources
    were already available has likely cost the program a significant
    amount in overpaid benefits.  From the time we made our
    recommendation on this issue until SSA begins using the HCFA system
    in November 1998, at least another 18 months will have passed without
    more timely identification of SSI recipients residing in nursing
    homes.  Furthermore, SSA plans only semiannual matches with the data,
    rather than monthly matches as we recommended.  This will permit
    overpayments to routinely accrue and go undetected for a significant
    amount of time.

    4.  In chapter 1 of this report we emphasize that SSI is a complex
    program that has changed significantly over time.  We also
    acknowledge the administrative difficulties SSA faces in determining
    eligibility and payment amounts for recipients whose financial
    circumstances change frequently.  However, our audit work and SSA's
    own quality reviews show that recipient nonreporting of essential
    eligibility information remains a significant and costly program
    vulnerability.  Thus, it is essential that more effective financial
    eligibility procedures be established and overpayment recoveries
    receive enhanced attention.  The fact that SSA says it is now
    developing a "comprehensive plan that attacks the growth in
    outstanding overpayment debt" appears to support our conclusion that
    additional focus is needed in this area.  Finally, we are aware that
    current laws preclude SSA from using more aggressive debt collection
    tools, such as credit bureaus, interest levies, and federal salary
    offsets to recover overpaid SSI benefits.  However, our point in this
    report is that, consistent with SSA's reactive approach to managing
    the SSI program, the agency did not take a leadership role in prior
    years to develop and sponsor legislative changes that would have
    provided SSA with additional recovery tools.  In fact, it was only
    after a number of GAO briefings over the last year, and a recent
    testimony in which we noted SSA's continued reluctance to pursue more
    aggressive debt collection tools, that SSA recently submitted a
    legislative proposal requesting additional recovery authorities.

    5.  In our report's section on the SSI program's vulnerability to
    fraud and abuse, we note that since becoming an independent agency,
    SSA has begun to take more decisive action to address fraud and abuse
    in the SSI program.  We also acknowledge the substantial increase in
    OIG investigative resources and the numerous agency initiatives
    designed to combat program fraud and abuse.  However, many of the
    initiatives were barely under way at the time of our review and it
    was too early to determine their impacts.  Our audit work and SSA's
    own recent studies did find that many years of inadequate attention
    to program integrity issues has fostered a strong skepticism among
    both headquarters and field staff that fraud prevention is an agency
    priority.  Overcoming this perception remains a significant challenge
    for SSA.

    6.  SSA's comments note that its recent legislative proposal
    requesting authority to suspend recipients who fail to report
    eligibility information negates our recommendation that SSA should
    seek authority to recover greater amounts than the current 10-percent
    limit from individuals who chronically abuse program reporting
    requirements.  While we do not dispute the potential value of SSA's
    legislative proposal, we believe that obtaining authority to withhold
    higher amounts would give field staff an additional means for
    deterring recipient nonreporting.  Currently, staff do not have this
    discretion, regardless of the number of times an individual fails to
    comply with program reporting requirements.  During our review, the
    10-percent limit was also noted by SSA management as a barrier to
    increased collections.  Thus, in some cases, increasing the limit
    would likely improve SSA's recovery efforts by allowing it to more
    quickly recover overpayments before recipients leave the SSI rolls
    because they have become employed or died and recovery from the
    individual or his or her survivors becomes less likely.

    7.  We disagree with SSA's view that a reassessment of current
    policies on imposing penalties for recipient nonreporting is
    unnecessary.  SSA's own quality reviews show that, on average, 77
    percent of all overpayments are attributable to recipient
    noncompliance with reporting requirements.  SSA has also reported in
    prior years that penalties are rarely used, even for individuals with
    a history of failing to comply with reporting requirements.  Given
    the infrequent use of penalties documented during our review and
    staff complaints that penalties are administratively burdensome to
    levy and too low to deter future nonreporting, we believe a review is
    necessary.

    8.  We do not agree with SSA's objection to developing specific
    requirements and performance measures to hold managers accountable
    for better verifying recipient eligibility information and combatting
    fraud and abuse.  If properly designed and managed, these measures
    would provide much needed incentives to encourage staff to devote
    more time to program integrity issues while servicing their daily
    workloads.  Such performance measures would also further demonstrate
    to field staff SSA management's commitment to protecting SSI benefits
    from being overpaid.

    9.  SSA's data show that outstanding SSI debt carried over from
    previous years was about $1.6 billion at the start of fiscal year
    1997.  New overpayment detections during the course of the year
    totaled about $1 billion dollars.  In response to SSA's comments, we
    have revised the report to more accurately reflect that outstanding
    debt and new detections totaled $2.6 billion in 1997.  Our report
    also notes that, during that year, SSA actually collected about $437
    million in overpayments owed the agency.

    10.  Between fiscal years 1989 and 1997, SSA wrote off about $1.8
    billion in overpaid benefits, including $562 million in 1997 alone.
    In response to SSA's comments, we have noted that the 1997 write-off
    included debt that SSA has carried on its books for many years and
    deemed not cost-effective to pursue.  In response to SSA's technical
    comments, we have also revised the report to more accurately reflect
    the total amount of unrecovered SSI overpayments experienced since
    fiscal year 1989.

    11.  As noted in our report, annual SSI overpayment collections have
    increased steadily.  However, the amount of outstanding SSI debt owed
    the agency has consistently outpaced its collection efforts.  Thus,
    we continue to believe that specific performance measures for the SSI
    program should be developed and included in SSA's programmatic plans
    for the purpose of monitoring SSA's progress in addressing critical
    areas of vulnerability.  At present, adequate measures are not
    included in SSA's plans, and by aggregating collection goals across
    all of its programs, SSA may lack the necessary management
    information to target future resources to problem areas in the SSI
    program.  In addition, aggregated performance data may also make it
    difficult for oversight entities such as SSA's OIG and GAO to assess
    SSA's progress in addressing its most significant SSI program
    vulnerabilities.

    12.  On the basis of a review of SSA's May 1998 legislative
    proposal--the Supplemental Security Income Integrity Act of 1998--we
    have incorporated into the body of this report SSA's recent efforts
    to restrict asset transfers.  Despite our requests to SSA, we have
    been provided no evidence to document the 1996 formal legislative
    proposal SSA refers to in its comments.

    --------------------
    \26 Supplemental Security Income:  Opportunities Exist for Improving
    Payment Accuracy (GAO/HEHS-98-75, Mar.  27, 1998).

    GAO CONTACTS AND STAFF
    ACKNOWLEDGMENTS
    ========================================================= Appendix III

    GAO CONTACTS

    Roland H.  Miller III, Project Manager, (202) 512-7246
    Dan Bertoni, Deputy Project Manager, (202) 512-5988

    STAFF ACKNOWLEDGMENTS

    In addition to those named above, the following individuals made
    important contributions to this report:  Nancy Cosentino, Deputy
    Project Manager; Jeremy Cox, Senior Evaluator; James P.  Wright,
    Assistant Director (Study Design and Analysis); and Jill Yost,
    Evaluator.

    RELATED GAO PRODUCTS

    Supplemental Security Income:  SSA Needs a Uniform Standard for
    Assessing Childhood Disability (GAO/HEHS-98-123, May 6, 1998).

    Supplemental Security Income:  Opportunities Exist for Improving
    Payment Accuracy (GAO/HEHS-98-75, Mar.  27, 1998).

    SSA's Management Challenges:  Strong Leadership Needed to Turn Plans
    Into Timely, Meaningful Action (GAO/T-HEHS-98-113, Mar.  12, 1998).

    Supplemental Security Income:  Timely Data Could Prevent Millions in
    Overpayments to Nursing Home Residents (GAO/HEHS-97-62, June 3,
    1997).

    High Risk Program:  Information on Selected High-Risk Areas
    (GAO/HR-97-30, May 16, 1997).

    Supplemental Security Income:  Long-Standing Problems Put Program at
    Risk for Fraud, Waste, and Abuse (GAO/T-HEHS-97-88, Mar.  4, 1997).

    High Risk Series:  An Overview (GAO/HR-97-1, Feb.  1997).

    High Risk Series:  Quick Reference Guide (GAO/HR-97-2, Feb.  1997).

    Supplemental Security Income:  SSA Is Taking Steps to Review
    Recipients' Disability Status(GAO/HEHS-97-17, Oct.  30, 1996).

    Supplemental Security Income:  SSA Efforts Fall Short in Correcting
    Erroneous Payments to Prisoners (GAO/HEHS-96-152, Aug.  30, 1996).

    Supplemental Security Income:  Administrative and Program Savings
    Possible by Directly Accessing State Data (GAO/HEHS-96-163, Aug.  29,
    1996).

    Supplemental Security Income:  Some Recipients Transfer Valuable
    Resources to Qualify for Benefits (GAO/HEHS-96-79, Apr.  30, 1996).

    Supplemental Security Income:  Disability Program Vulnerable to
    Applicant Fraud When Middlemen Are Used (GAO/HEHS-95-116, Aug.  31,
    1995).

    Social Security Administration:  Leadership Challenges Accompany
    Transition to an Independent Agency (GAO/HEHS-95-59, Feb.  15, 1995).

    *** End of document. ***