More Diligent Followup Needed To Weed Out Ineligible SSA Disability Beneficiaries

The Disability Insurance program (DI), administered by the Social Security Administration (SSA), was established in 1954 to prevent the erosion of retirement benefits of wage earners who become disabled and are prevented from continuing payments into their social security account. The program was expanded in 1956 to authorize cash benefit payments to the disabled. Applications for disability benefits are processed by claims representatives who interview the claimant and prepare disability and vocational reports for use by state agencies. These agencies carry out the disability determination process under agreements with the Department of Health and Human Services (HHS). The Continuing Disability Investigation (CDI) process is the SSA method of identifying beneficiaries who may have medically recovered or regained the ability to work and assessing their continuing eligibility for disability benefits. One of the key features of the CDI process is medical reexamination. Primarily, GAO focused on SSA efforts to review the continuing eligibility of DI beneficiaries. SSA actions to correct previously noted deficiencies were also addressed.

SSA has not adequately followed up on DI beneficiaries to verify that they remain disabled. It has limited its reviews to a small percentage of beneficiaries. Most beneficiaries never have their eligibility reviewed and can remain on the rolls until they voluntarily return to work, reach age 65, or die. Even beneficiaries who have met the criteria for reexamination have not always been investigated. As a result of the limited SSA followup activity and poor management of the CDI process, as many as 584,000 beneficiaries who do not currently meet the SSA eligibility criteria may be receiving disability benefits. Furthermore, inefficiencies in the CDI program often result in program overpayments. Beneficiaries who returned to work were often paid benefits to which they were not entitled because SSA was slow to investigate and terminate their benefits. While SSA has not adequately monitored the disability rolls, it has initiated plans to increase the number and effectiveness of investigations.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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