United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1997-06-03 monographic deposited born digital 37 p. GA 1.13:HEHS-97-62 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-97-62 P0b002ee18038f5e4 f:he97062 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-97-62 machine generated eng fdlp REPORT GAOREPORTS-HEHS-97-62 HEHS-97-62 Overpayments Income maintenance programs Electronic data interchange Computer security State-administered programs Computer matching Nursing homes Reporting requirements Federal/state relations Right of privacy Supplemental Security Income Program SSA Supplemental Security Record Data Base Medicaid Program Texas New York Tennessee Medicaid Statistical Information System HCFA Medicaid Management Information System Resident Assessment Instrument System SSA File Transfer Management System Letter Report HEHS Pursuant to a congressional request, GAO reviewed overpayments to Supplemental Security Income (SSI) recipients in nursing homes and other medical treatment institutions, focusing on: (1) the extent of such overpayments; (2) the success or failure of the Social Security Administration's (SSA) actions in preventing and detecting these overpayments; and (3) the methods by which SSA can better prevent such overpayments.<p/>GAO noted that: (1) SSA estimates that overpayments to individuals in nursing homes may exceed $100 million annually; however, the exact extent is unknown; (2) despite SSA procedures to prevent overpayments, and recent legislation designed to further help prevent these overpayments to SSI recipients in nursing homes, GAO determined, based on SSA data, that it had detected overpayments totaling $24 million to about 31,000 recipients in fiscal year 1995; (3) in two states GAO visited, New York and Texas, GAO determined that SSA may not have been aware of an additional 1,699 SSI recipients recently admitted to nursing homes during a 1-month period and potentially overpaid these individuals $515,714 in benefits during the subsequent month alone; (4) SSA efforts to prevent these overpayments or detect them in a timely manner have had little success; (5) in many cases, recipients or their representative payees did not report the change in living arrangements in a timely manner; (6) in addition, because of other work priorities, SSA field representatives have not routinely contacted the over 23,000 U.S. nursing homes to solicit their cooperation in notifying SSA of admissions of SSI recipients, as SSA policies require; (7) furthermore, GAO's analysis of SSA data shows that overpayments to SSI recipients residing in nursing homes have increased by nearly 13 percent since the October 1995 effective date of the legislation that was designed to reduce overpayments; (8) SSA could more quickly detect overpayments by electronically obtaining nursing home admissions data directly from states to help identify recent changes in recipients' living arrangements; (9) SSA could then use an automated interface to automatically adjust the benefits of SSI recipients admitted to nursing homes who are ineligible for continuation of benefits due to temporary institutionalization and prevent the occurrence of overpayments for the ensuing months; (10) in the states GAO visited, GAO found that the state Medicaid agencies can make these data available to SSA; (11) SSA could use an existing data exchange system with states to obtain the needed data electronically; (12) in the interim period, while some states prepare their automated systems to make the electronic exchange of data with SSA, states could provide SSA with tapes or paper listings of this information for SSA's use in detecting overpayments; and (13) to identi* https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-97-62/html/GAOREPORTS-HEHS-97-62.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-97-62/pdf/GAOREPORTS-HEHS-97-62.pdf GAO/HEHS-97-62 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-97-62 Letter Report GAO/HEHS-97-62; Supplemental Security Income: Timely Data Could Prevent Millions in Overpayments to Nursing Home Residents; Overpayments Income maintenance programs Electronic data interchange Computer security State-administered programs Computer matching Nursing homes Reporting requirements Federal/state relations Right of privacy Supplemental Security Income Program SSA Supplemental Security Record Data Base Medicaid Program Texas New York Tennessee Medicaid Statistical Information System HCFA Medicaid Management Information System Resident Assessment Instrument System SSA File Transfer Management System Public Law 103-387