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 1999-09-15 monographic deposited born digital 39 p. GA 1.13:HEHS-99-151 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-151 P0b002ee180376d2d f:he99151 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-99-151 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-151 HEHS-99-151 Fraud Program abuses Disability benefits Internal controls Income maintenance programs Social security benefits Supplemental Security Income Program SSI Letter Report HEHS Pursuant to a congressional request, GAO provided information on the Supplemental Security Income (SSI) program's vulnerability to fraud and abuse, focusing on: (1) the extent to which SSI is vulnerable to individuals who obtain eligibility by feigning disabilities with the help of middlemen and medical providers; (2) the Social Security Administration's (SSA) methods for preventing, detecting, and responding to this type of program fraud and abuse; and (3) additional strategies SSA could use to more effectively address this problem.<p/>GAO noted that: (1) although the number of people who have feigned injuries or illnesses to obtain SSI benefits is unknown, the SSI program is vulnerable to this type of fraud and abuse; (2) many SSI beneficiaries' impairments are difficult to objectively verify; (3) from a sample file of beneficiaries--developed by SSA to research characteristics of the SSI population--GAO found that more than 60 percent had such impairments, including psychoses, schizophrenia, and other mental disorders, as well as a range of physical disorders; (4) in addition, providers who have been investigated for defrauding Medicaid, Medicare, or private insurance companies furnished at least some portion of the supporting medical evidence for more than 12,000 of the 208,000 SSI disabled recipients in the 6 states GAO examined; (5) over 96 percent of the 158 officials and staff GAO interviewed said they believed that the practice of middlemen helping people improperly qualify for SSI benefits has continued; (6) SSA has taken several actions to reduce the program's vulnerability to this and other forms of fraud; (7) SSA has: (a) established pilot fraud investigation teams in five states during 1998 to examine individual cases where significant fraud and abuse is suspected; (b) developed new policies and procedures to make it easier to deny claims or terminate benefits when program fraud or abuse is detected; and (c) strengthened its ability to handle its non-English speaking clients; (8) these steps have achieved positive results; (9) front-line staff largely rely on their experience and perceptions to identify suspicious claims; they lack other valuable information, such as the names of middlemen and medical providers suspected of fraudulent or abusive practices by other employees or organizations, that could help them judge a claim's validity; (10) SSA and Disability Determination Services (DDS) staff said that they do not always follow the new procedures because they believe the procedures conflict with agency work incentives that stress speed in processing claims and because they believe they are not adequately protected from legal liability that could arise if they were to follow claims denial procedures; (11) they also question the agency's commitment to fighting fraud, since they repeatedly see the same suspicious middlemen and medical providers involved in SSI cases, despite previous referrals for investigation; and (12) several additional types of actions could reduce SSI's vulnerability to fraud and abuse by middlemen and medical providers. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-151/html/GAOREPORTS-HEHS-99-151.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-151/pdf/GAOREPORTS-HEHS-99-151.pdf GAO/HEHS-99-151 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-151 Letter Report GAO/HEHS-99-151; Supplemental Security Income: Additional Actions Needed to; Fraud Program abuses Disability benefits Internal controls Income maintenance programs Social security benefits Supplemental Security Income Program SSI