Supplemental Security Income
Sustained Management Attention Needed to Address Residency Violations
Gao ID: GAO-04-789T May 20, 2004
The Supplemental Security Income (SSI) program paid about $36 billion in benefits to about 6.9 million recipients in 2003. In recent years, the Social Security Administration (SSA) has identified a general increase in the amount of annual overpayments made to recipients who are not present in the U.S. as required by SSI program guidelines--a problem we refer as "residency violations." This problem has caused concern among both program administrators and policy makers. As such, GAO was asked to determine what is known about the extent to which SSI benefits are improperly paid to individuals who are not present in the United States and to identify any weaknesses in SSA's processes and policies that impede the agency's ability to detect and deter residency violations.
Overpayments resulting from residency violations totaled about $118 million between 1997 and 2001. Additionally, the extent of violations appears to vary by geographic region, with overpayments being more prevalent in several large metropolitan areas. GAO found that 54 percent of all overpayments detected by SSA during this period occurred in just 15 counties. In addition, we found that recipients born outside the United States accounted for at least 87 percent of all residency overpayments. SSA's ability to detect and deter residency violations is impeded by three kinds of weaknesses. First, the agency relies heavily on self-reported information from recipients to determine domestic residency, often without independently verifying such information. Second, SSA makes insufficient use of existing tools to detect violations, such as its "risk analysis" system, redeterminations, and home visits. Finally, the agency has not adequately pursued independent sources of information from other federal agencies or private organizations to detect nonresidency of SSI recipients. GAO recognizes that the SSI program is complex to administer, and residency requirements are particularly difficult to enforce because they can necessitate time-consuming, labor-intensive verification checks, such as home visits. However, SSA has not employed a systematic, comprehensive approach to this problem that would allow the agency to use its available systems and procedures more efficiently and reduce the program's exposure to additional violations.
GAO-04-789T, Supplemental Security Income: Sustained Management Attention Needed to Address Residency Violations
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Testimony:
Before the Subcommittee on Human Resources, Committee on Ways and
Means, House of Representatives:
United States General Accounting Office:
GAO:
For Release on Delivery Expected at 10:00 a.m. EDT:
Thursday, May 20, 2004:
SUPPLEMENTAL SECURITY INCOME:
Sustained Management Attention Needed to Address Residency Violations:
Statement of Robert E. Robertson, Director, Education, Workforce, and
Income Security Issues:
GAO-04-789T:
GAO Highlights:
Highlights of GAO-04-789T, a testimony before the Chairman,
Subcommittee on Human Resources, Committee on Way and Means, House of
Representatives
Why GAO Did This Study:
The Supplemental Security Income (SSI) program paid about $36 billion
in benefits to about 6.9 million recipients in 2003. In recent years,
the Social Security Administration (SSA) has identified a general
increase in the amount of annual overpayments made to recipients who
are not present in the U.S. as required by SSI program guidelines”a
problem we refer as ’residency violations“. This problem has caused
concern among both program administrators and policy makers. As such,
GAO was asked to determine what is known about the extent to which SSI
benefits are improperly paid to individuals who are not present in the
United States and to identify any weaknesses in SSA‘s processes and
policies that impede the agency‘s ability to detect and deter residency
violations.
What GAO Found:
Overpayments resulting from residency violations totaled about $118
million between 1997 and 2001. However, this figure, which represents
only violations detected by SSA, likely understates the true level of
the problem. Additionally, the extent of violations appears to vary by
geographic region, with overpayments being more prevalent in several
large metropolitan areas. GAO found that 54 percent of all overpayments
detected by SSA during this period occurred in just 15 counties. In
addition, we found that recipients born outside the United States
accounted for at least 87 percent of all residency overpayments.
SSA‘s ability to detect and deter residency violations is impeded by
three kinds of weaknesses. First, the agency relies heavily on self-
reported information from recipients to determine domestic residency,
often without independently verifying such information. Second, SSA
makes insufficient use of existing tools to detect violations, such as
its ’risk analysis“ system, redeterminations, and home visits. Finally,
the agency has not adequately pursued independent sources of
information from other federal agencies or private organizations to
detect nonresidency of SSI recipients. GAO recognizes that the SSI
program is complex to administer, and residency requirements are
particularly difficult to enforce because they can necessitate time-
consuming, labor-intensive verification checks, such as home visits.
However, SSA has not employed a systematic, comprehensive approach to
this problem that would allow the agency to use its available systems
and procedures more efficiently and reduce the program‘s exposure to
additional violations.
Top 15 Counties for SSI Residency Overpayments (1997-2001):
[See PDF for image]
[End of figure]
What GAO Recommends:
GAO has made recommendations to the Commissioner of Social Security
that will allow the agency to make optimal use of existing tools and
new data sources to better detect potential residency violators.
www.gao.gov/cgi-bin/getrpt?GAO-04-789T.
To view the full report, including the scope and methodology, click on
the link above. For more information, contact Robert E. Robertson (202)
512-7215 or RobertsonR@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to be here to discuss the Supplemental Security Income
(SSI) program. The Social Security Administration (SSA) administers the
SSI program, which is the nation's largest cash assistance program for
the poor. SSI provides financial assistance to people who are age 65 or
older, blind or disabled, and who have limited income and resources. In
2003, about 6.9 million recipients were paid about $36 billion in SSI
benefits.[Footnote 1] Benefit eligibility and payment amounts for SSI
recipients are determined by complex and often difficult to verify
factors such as individual living arrangements, including whether a
person resides in the United States (U.S.). Thus, the SSI program tends
to be difficult to administer and susceptible to overpayments.[Footnote
2] In recent years, SSA has identified a general increase in the amount
of annual overpayments made to recipients who are not present in the
U.S. as required by SSI program guidelines--a problem we refer to as
"residency violations.":
My testimony today focuses on a report we issued in July 2003 in
response to a request from this subcommittee.[Footnote 3] You asked us
to (1) determine what is known about the extent to which SSI benefits
are improperly paid to individuals who are not present in the U.S. and
(2) identify any weaknesses in SSA's processes and policies that impede
the agency's ability to detect and deter residency violations.
In summary, SSA detected overpayments of $118 million for residency
violations between 1997 and 2001,[Footnote 4] but interviews with the
Office of Inspector General (OIG) and agency officials suggest that the
agency only detected a portion of the violations that occur each year,
at least in some parts of the country. The extent of violations appears
to vary by geographic region, with overpayments being more prevalent in
several large metropolitan areas in five states--California, Florida,
Illinois, New Jersey, and New York. We also found that recipients born
outside the U.S. accounted for at least 87 percent of all residency
overpayments. Three kinds of weaknesses have historically impeded SSA's
ability to detect and deter residency violations. First, to verify
domestic residency, the agency has often relied on self-reported
information from recipients and visual inspection of documents that can
be easily manipulated, such as rent receipts and letters from neighbors
or clergy. Second, the agency has historically made limited use of
tools at its disposal to detect possible violators, such as its risk
analysis system to screen for high-risk cases more likely to result in
overpayments. Third, SSA has not adequately pursued the use of
independent, third-party data, such as emerging immigration databases
or recipient bank account information, to help detect residency
violations.
In response to our report recommendations, SSA indicated that it is
considering implementing several initiatives that may provide a more
complete picture of residency violations in the SSI program and improve
its ability to detect and prevent such violations in a more efficient,
timely manner. These include investigating the potential for obtaining
access to foreign automated teller machines to track banking
transactions over time, requesting assistance from state Medicaid fraud
investigators to help SSA perform more home visits to verify
recipients' residence, and investigating the potential of examining
arrival/departure records maintained by the Department of Homeland
Security to identify recipients who leave the country for more than 30
consecutive days. While it is too early to assess how effective these
initiatives may be, we support SSA's commitment to studying this
problem further and its willingness to explore new data sources and
improvements to existing processes as a way of detecting potential
violations in a more timely manner. Thus, we view these initiatives as
positive first steps. However, sustained management attention to
identifying and preventing residency violations will be needed to
further strengthen the integrity of the SSI program.
Background:
Individuals may apply for SSI benefits at any of about 1,300 SSA field
offices. During the initial interview, SSA staff solicit information on
applicants' financial situation and the disability being claimed.
Applicants are required to report any information that may affect their
eligibility for benefits, such as income, resources, and their living
arrangements (including current residence). Similarly, once
individuals receive SSI benefits, they are required to report changes
in their address or residence to SSA in a timely manner. The Social
Security Act (Section 1614 (a)(1)(B)(i)) requires that an individual be
a resident of the U.S. to be eligible for SSI payments. SSA guidelines
define a resident of the U.S. as a person who has established a
dwelling in the U.S. with the intent to live in the country. Section
1611(f) of the act also provides that no individual is eligible for SSI
payments for any month during all of which the individual is outside
the U.S. Recipients who fail to establish residency in accordance with
SSI program guidelines or do not report absences of 30 days or more may
be overpaid, and subject to monetary penalties and administrative
sanctions such as suspension of benefits. Similarly, SSI recipients who
become ineligible for SSI benefits because they violate SSI residency
guidelines may also be ineligible to receive Medicaid benefits.
To a significant extent, SSA depends on program applicants and current
recipients to accurately report important eligibility information. To
verify this information, SSA may use computer matches to compare SSI
records against recipient information in records of third parties such
as other federal agencies. SSA also periodically conducts
"redetermination" reviews to verify important eligibility factors, such
as income and resources, to determine whether recipients remain
eligible for benefits after the initial assessment.
SSA Detected Overpayments of $118 Million for Residency Violations over
5 Years, but More May Go Undetected:
SSA detected overpayments of $118 million for residency violations
between 1997 and 2001, but interviews with OIG and SSA officials
suggest that the agency detects only a portion of the violations that
occur each year, at least in some parts of the country. Special
initiatives of limited duration conducted by SSA and its OIG have
uncovered additional residency overpayments. According to our own
analysis of SSA's data, residency overpayments appear to vary by
geographic region, with the majority of overpayments having been
detected in several large metropolitan areas. Finally, we determined
that most of the overpayments detected during this period were
attributable to recipients who were born outside the U.S.
Residency Violations May be More Prevalent than SSA Has Detected:
SSA detected an average of about 46,000 recipient residency violations
annually between 1997 and 2001, resulting in $118 million in
overpayments. While SSA's data show that less than 1 percent of all SSI
recipients violate residency requirements annually, SSA field staff and
OIG officials suggest that the problem may be more prevalent. For
example, over the past few years, SSA and its OIG have initiated a
number of studies estimating that residency violations in certain
regions of the country may represent as much as 26 percent of SSI cases
in those areas. These local studies were generally limited in duration
and were performed within specific geographic areas:
* A 1997 SSA and OIG joint study of SSI residency used home visits in
southern California to identify potential residency violations. The
study concluded that about 25 percent of SSI recipients in one field
office were living outside of the country. The study also determined
that 47 percent of SSI recipients from this field office could not be
located at their reported residence, an indication that they may be
violating residency requirements.
* A 1998 OIG eligibility study in El Paso, Texas, found that about 26
percent of recipients investigated were violating residency
requirements. This project identified about $3 million in residency
overpayments.
* In 1998 and 1999, joint SSA/OIG studies examined 32,641 recipients in
New York and California who had not used their Medicaid benefits for at
least 1 year.[Footnote 5] Using redetermination reviews, these studies
found that 1,281 recipients (about 4 percent) were living outside the
U.S.[Footnote 6]
Many Violations Are Geographically Concentrated:
Our analysis of SSA's data showed that overpayments due to residency
violations are more prevalent in a number of large metropolitan areas.
For example, overpayments from violations detected in Los Angeles
County, California, represented 10.5 percent of the nation's SSI
residency overpayments between 1997 and 2001. Overall, we found that
just 15 counties in 5 states--California, Florida, Illinois, New
Jersey, and New York--accounted for 54 percent of all residency
overpayments detected by SSA during this period. (See fig. 1.) In
addition to Los Angeles County, there were other counties with a
significant percentage of SSI residency overpayments: Queens County,
N.Y. (5.2 percent); New York County, N.Y. (5.0 percent); Kings County,
N.Y. (4.8 percent); San Diego County, Calif. (4.1 percent); and Bronx
County, N.Y. (3.5 percent). Moreover, of approximately 3,000 U.S.
counties, 50 accounted for 77 percent of all residency overpayments
detected by SSA during this time. (See fig. 1.):
Figure 1: Top 15 Counties for SSI Residency Overpayments, 1997-2001:
[See PDF for image]
[End of figure]
Most Overpayments Were Made to Recipients Born Outside the U.S.
SSA's data also showed that individuals born outside the U.S. accounted
for at least 87 percent of all SSI residency overpayments between 1997
and 2001.[Footnote 7] Residency overpayments were most common among
recipients who were born in Latin America, the Caribbean, and South/
Southeast Asia, but included other areas as well, such as the Middle
East. Recipients from the Philippines accounted for the greatest amount
of residency violations or $24 million of all SSI residency
overpayments during this period. SSA data also showed that recipients
from just 14 countries and 1 U.S. territory accounted for about 73
percent of all residency overpayments during this period. These include
the Dominican Republic, (12.3 percent), Mexico (7.6 percent), Puerto
Rico (7.5 percent), India (7.1 percent), and Iran (3.4 percent). (See
fig. 2.):
Figure 2: Top 15 Countries of Origin for SSI Residency Overpayments,
1997-2001:
[See PDF for image]
[A] Puerto Rico is a United States territory.
[End of figure]
Reliance on Self-Reported Information and Other Vulnerabilities Have
Impeded SSA's Ability to Detect and Deter Violations:
SSA's ability to detect and deter residency violations has been impeded
by three kinds of weaknesses. First, the agency has relied heavily on
self-reported information from recipients to determine domestic
residency, often without independently verifying such information.
Second, SSA has made insufficient use of its existing tools for
identifying potential violations, such as its risk analysis system to
screen for high-risk cases. SSA has also not made optimal use of
redetermination reviews, home visits, monetary penalties, and
administrative sanctions to deter future violations. Finally, the
agency historically has not made adequate use of independent data
sources from other federal agencies or private organizations to detect
nonresidency of SSI recipients.
SSA Has Relied Heavily on Self-Reported Information That Can be
Manipulated:
SSA has relied on self-reported information, such as documents and
statements from recipients, to establish proof of U.S. residency. Our
prior work has shown that about 77 percent[Footnote 8] of all payment
errors in the SSI program were attributable to recipients who do not
comply with reporting requirements.[Footnote 9] In our recent review,
about half the SSA field staff we interviewed reported that they relied
on recipients to self-report important information with respect to
travel outside the U.S. SSI program guidelines have generally directed
SSA staff to accept recipients' assertions concerning residency unless
they have reason to question the accuracy of their statements. If SSA
field staff have reason to believe that a recipient has been outside
the country for more than 30 days, they may request additional
documentation such as a plane ticket, passport (or similar evidence
which establishes date of entry into the U.S.), or a signed statement
from one or more U.S. residents such as neighbors, clergy, or others
who may have knowledge of the individual's whereabouts. However,
program guidelines do not require field staff to perform any additional
verification steps to establish recipients' residency. [Footnote 10]
We also learned that some of the documents accepted by SSA as proof of
residence are subject to manipulation or forgery. For example, staff in
one field office noted that documents such as rent receipts can be
purchased from a local drugstore and easily forged. Other field staff
said that statements from neighbors could be falsified or manipulated
to support assertions that an individual has not traveled outside the
country. Field staff also reported that recipients may use multiple
passports in order to conceal extended stays outside the country. For
example, staff in two SSA regions we visited said that SSI recipients
sometimes use a foreign passport to exit and reenter the country while
maintaining a separate, "clean" U.S. passport for evidence of
continuing residency.
Given the agency's reliance on self-reported information, SSA field
staff often used their personal experience, judgment, and ad hoc
interviewing procedures to detect potential residency violations. In
particular, SSA field staff have looked for inconsistencies in
recipient statements or a recipient's inability to answer simple
questions about where they live. For example, recipients may be asked
about the names of people living in their household, or basic facts
about their neighborhood such as the location of a well-known landmark.
Staff may also ask whether a recipient owns property outside the U.S.
Questionable or inconsistent answers to such questions may result in
requests to provide additional documentation. However, effectively
identifying residency violators has often depended on the experience
and persistence of individual staff.
Our review also found that the procedures for documenting recipients'
residency varied widely among the offices we visited, in particular,
the number and types of evidentiary documents requested by staff. While
staff in several offices reported that they often request only the most
basic documentation required by SSI program guidelines, staff in other
offices told us that they routinely ask for additional documentation
for recipients, such as a second passport or other travel documents to
determine whether the individual has been outside the country for more
than 30 days. While these steps are not required, some field staff
reported that they have been effective in identifying potential
violators and deterring future violations. SSA staff reported a number
of reasons for different documentation requirements such as variance in
individual office policies, personal preferences based on experience,
time pressures to complete cases, and the inability to effectively
verify supplied documentation.
SSA Has Not Fully Exploited Its Tools for Detecting and Deterring
Program Violations:
SSA has not made optimal use of several tools that could be used to
detect residency violations. These include its "risk analysis system"
for screening cases more likely to result in overpayments, its
"redetermination reviews" of recipients' eligibility, and home visits
to verify recipients' whereabouts. SSA has used statistical risk
analysis techniques for many years in the SSI program to identify
recipients who are more likely to be overpaid due to excess income or
resources. Since SSA lacks adequate staff resources to conduct an
annual review of every recipient, it uses this technique to identify
recipients who are most likely to have a change in their eligibility
status or benefit amount. [Footnote 11]
Despite the proven effectiveness of its risk analysis system to help
the agency identify cases with the highest potential for overpayments,
SSA has not used this tool to specifically identify potential residency
violations. To determine whether it would be possible for SSA to more
effectively identify potential residency violators by using its
existing systems, we developed and tested a statistical model of
factors possibly associated with residency violations.[Footnote 12]
Using this model as a screen, we examined all recipients who were
currently in violation of residency requirements as of April
2003,[Footnote 13] and found that recipients born outside the U.S.--
noncitizens as well as naturalized citizens--were more than 40 times as
likely to be violating residency requirements than were native-born
recipients. Similarly, recipients with prior residency violations were
about 10 times as likely to be current violators compared with
recipients who have no prior violations. We also found that recipients
who used post office boxes were somewhat more likely to be receiving
benefits outside the country than those without post office boxes.
Given the potential usefulness of this limited modeling demonstration,
it may be possible for SSA to expand and refine its risk analysis
system to better target potential violators. SSA is studying the
potential for refining its screening technique to improve its
effectiveness for identifying recipients at high risk for residency
violations.
Beyond the targeting problems we identified with SSA's risk analysis
system, we found that the agency was not using redeterminations as
efficiently as it could despite the fact that SSA's data and our prior
reviews have documented their effectiveness for verifying recipients'
eligibility.[Footnote 14] In particular, home visits were used
infrequently during redetermination reviews according to staff in a
number of offices we visited.
Those field offices that have used home visits as part of their
redetermination procedures have found them effective. About half of the
field offices we visited (9 of 17) employed home visits at least some
of the time to verify whether recipients actually live at the address
they report to SSA. For example, the SSA regional office in Dallas,
Texas contracted with a private investigation firm to conduct residency
home visits. Using these investigators, field offices within the region
performed 4,200 home visits that uncovered at least $2.1 million in
additional overpayments between October 1997 and January 2003.
According to SSA data, this project achieved a benefit-to-cost ratio of
almost 8 to 1. Similarly, the California Department of Health Services
has worked cooperatively with SSA field offices in the San Diego area
by conducting residency home visits. Because Medicaid eligibility is
often directly tied to SSI eligibility, identifying residency
violations may save funds from both programs. Between October 2000 and
September 2002, state Medicaid investigators identified about 1,600 SSI
recipients with residency violations. In one instance, state
investigators discovered an SSI recipient who was using a residence in
southern California as a mailing address, while actually residing in
Tijuana, Mexico, for at least 8 years. In another case, state
investigators found an SSI recipient using a post office box in
southern California as a mailing address, although the recipient was in
fact living in San Felipe, Mexico, since 1982. Because the state
provides these investigative services to SSA free of charge, it is
highly cost-effective. To address this issue, SSA is currently
exploring the potential for having states assist in performing home
visits using their Medicaid fraud investigators. According to SSA, 27
states and the District of Columbia have expressed an interest in
assisting in this effort.
In terms of deterring future violations, we found that existing
monetary penalties and administrative sanctions are rarely, if ever,
used in the offices we visited.[Footnote 15] For example, about 72
percent of the field staff we interviewed said that penalties or
sanctions are not used in their offices, or are only used occasionally.
National data on SSA's use of monetary penalties and administrative
sanctions also suggest that these tools are not routinely utilized for
recipients who fail to report important information that can affect
their eligibility, including absences from the country. In a recent
report, we estimated that at most about 3,500 recipients were penalized
for reporting failures in fiscal year 2001.[Footnote 16] Under the law,
SSA may impose monetary penalties on recipients who do not file timely
reports about factors or events that can affect their benefits. A
penalty causes a reduction in 1 month's benefits. Penalty amounts are
$25 for a first occurrence, $50 for a second occurrence, and $100 for
the third and subsequent occurrences. The penalties are meant to
encourage recipients to file accurate and timely information. However,
a large number of staff we interviewed noted that monetary penalties
are too low to be an effective deterrent against future residency
violations.
The Foster Care Independence Act of 1999 (Pub. L. No. 106-169) gave SSA
authority to impose administrative sanctions on persons who
misrepresent material facts that they know, or should have known, were
false or misleading. In these circumstances, SSA may suspend benefits
for up to 24 months. Despite having this authority, we found that
benefit suspensions are rarely if ever used by field staff for
residency violators. In fact, administrative sanctions were only
imposed in 21 cases nationwide as of January 2002.[Footnote 17] A
substantial number of staff told us that they rarely use sanctions
because the process for imposing them is often time-consuming and
cumbersome. In addition, some staff reported that SSA management does
not encourage the use of penalties or sanctions to deter residency
violations. SSA is currently evaluating its policies for imposing
monetary penalties and administrative sanctions.[Footnote 18]
SSA Had Not Actively Pursued Third-Party Data Sources to Detect
Potential Violators:
While SSA uses third-party information to verify certain aspects of
recipients' eligibility such as income, we found that the agency has
historically lacked adequate outside data sources to verify that
recipients are residents of the U.S.[Footnote 19] The agency currently
receives periodic paper reports from immigration officials on
noncitizens who have current and planned absences from the U.S. and
sends them to the appropriate SSA field offices for follow up. However,
these procedures are only effective for recipients who voluntarily
report their absence to immigration officials. Thus, SSA will remain
limited in its ability to independently verify the residency of SSI
recipients who deliberately seek to conceal extended periods outside
the country. Over half of the SSA managers and field staff we
interviewed told us that access to automated immigration data would
help them to more accurately verify recipients' residency. We have
recommended that SSA consider using a new system called the U.S.
Visitor and Immigrant Status Indicator Technology system (US VISIT) to
verify some recipients' entry and exit from the country. It is
currently being used by the Department of Homeland Security and will
incorporate existing entry-exit databases. When fully implemented, this
system will provide a mechanism to monitor major ports of entry/exit in
the U.S., including land crossings, seaports, and airports. As noted
previously, SSA is examining the potential for obtaining access to the
system to identify SSI recipients who reside outside the U.S. for more
than 30 consecutive days.
SSA has also not fully utilized its authority to obtain independent
data from other sources such as financial institutions as a tool for
detecting potential residency violations. The Foster Care Independence
Act of 1999 (FCIA) granted SSA new authority to verify recipients'
financial accounts. To implement this authority, SSA issued proposed
regulations on its new processes for accessing financial data in May
2002.[Footnote 20] In September 2003, the agency issued its final
regulations. SSA is testing processes to access the records of
financial institutions and credit bureaus to detect unreported income
or resources of SSI applicant and recipients. However, it is not clear
whether SSA plans to use financial institution data more broadly to
detect potential residency violations. In particular, it may be missing
potentially helpful sources of information such as data on recipients
who conduct banking transactions outside the U.S. using ATMs. As noted
previously, a large proportion of the residency overpayments SSA
detected between 1997 and 2001 were tied to recipients who originated
in various countries in Latin America and South/Southeast Asia.
However, SSA currently has no way to identify recipients who withdraw
SSI benefits from ATMs outside the U.S. Information we obtained from a
national financial data vendor indicates that it is now possible for
authorized users to obtain detailed information on individuals'
financial transactions from a large number of national and
international institutions. SSA may be able to obtain data for
recipients whose SSI benefits are direct-deposited into a U.S. bank and
then withdrawn from automated teller machines outside the country over
extended time periods. In response to our recommendation, SSA has
indicated that it would explore the feasibility of obtaining such
information to identify recipients who reside outside the U.S. for more
than 30 consecutive days.
Mr. Chairman, this concludes my prepared statement. I will be happy to
respond to any questions you or other Members of the Subcommittee may
have.
GAO Contacts and Staff Acknowledgments:
For information regarding this testimony, please contact Robert E.
Robertson, Director, or Daniel Bertoni, Assistant Director, Education,
Workforce, and Income Security Issues at (202) 512-7215. Individuals
making contributions to this testimony include Susan Bernstein, Jeff
Bernstein, Jeremy Cox, Sal Sorbello, Vanessa Taylor, Wendy Turenne, and
Shana Wallace.
[End of section]
Related GAO Products:
Supplemental Security Income: Progress Made in Detecting and Recovering
Overpayments, but Management Attention Should Continue. GAO-02-849.
Washington, D.C.: September 16, 2002.
Supplemental Security Income: Status of Efforts to ImproveOverpayment
Detection and Recovery. GAO-02-962T. Washington, D.C.: July 25, 2002.
Social Security Administration: Agency Must Position Itself Now to Meet
Challenges. GAO-02-289T. Washington, D.C.: May 2, 2002.
Social Security Administration: Status of Achieving Key Outcomes and
Addressing Major Management Challenges. GAO-01-778. Washington, D.C.:
June 15, 2001.
High Risk Series: An Update. GAO-01-263. Washington, D.C.: January
2001.
Major Management Challenges and Program Risks: Social Security
Administration. GAO-01-261. Washington, D.C.: January 2001.
Supplemental Security Income: Additional Actions Needed to Reduce
Program Vulnerability to Fraud and Abuse. GAO/HEHS-99-151. Washington,
D.C.: September 15, 1999.
Supplemental Security Income: Long-Standing Issues Require More Active
Management and Program Oversight. GAO/T-HEHS-99-51. Washington, D.C.:
February 3, 1999.
Major Management Challenges and Program Risks: Social Security
Administration. GAO/OCG-99-20. Washington, D.C.: January 1, 1999.
Supplemental Security Income: Action Needed on Long-Standing Problems
Affecting Program Integrity. GAO/HEHS-98-158. Washington, D.C.:
September 14, 1998.
Supplemental Security Income: Opportunities Exist for Improving Payment
Accuracy. GAO/HEHS-98-75. Washington, D.C.: March 27, 1998.
High Risk Program: Information on Selected High-Risk Areas. GAO/HR-97-
30. Washington, D.C.: May 16, 1997.
High Risk Series: An Overview. GAO/HR-97-1. Washington, D.C.: February
1997.
FOOTNOTES
[1] This figure includes both federal funds and state supplemental
funds.
[2] In 2001, outstanding SSI debt and newly detected overpayments for
the year totaled $4.7 billion.
[3] See U.S. General Accounting Office, Supplemental Security Income:
SSA Could Enhance Its Ability to Detect Residency Violations,
GAO-03-724 (Washington, D.C.: July 29, 2003).
[4] More recent data on overpayments due to residency violations were
not available at the time of this testimony.
[5] The rationale for targeting these cases was that financially needy
individuals who were aged or disabled are likely to use Medicaid
services on a regular basis. Thus, SSI recipients who have not used
Medicaid for long periods of time may have left the U.S. or died.
[6] These studies considered the effect of only one potential indicator
of residency violations--Medicaid nonutilization.
[7] The percentage of total residency overpayments attributed to
recipients born outside of the U.S. may be higher than 87 percent
because SSA could not identify a specific country of birth for
recipients that represent about $10 million in SSI overpayments.
[8] This figure represents data from fiscal years 1991 through 1995.
[9] See U.S. General Accounting Office, Supplemental Security Income:
Action Needed on Long-Standing Problems Affecting Program Integrity,
GAO/HEHS-98-158 (Washington, D.C.: Sept. 14, 1998).
[10] SSI program guidance allows field staff to use home visits in
selected circumstances, such as in response to a report from a third
party that a recipient is outside the U.S. In addition, home visits may
be employed if a recipient fails to provide information requested by
SSA staff, or if a recipient does not respond to letters and/or
telephone calls from staff asking them to appear at the local office.
However, program guidelines give field office managers discretion in
determining when to use home visits and allow them to take into
consideration factors such as the safety of staff who perform such
visits.
[11] SSA's risk analysis system incorporates about 48 different
characteristics--or variables--to help the agency determine which
recipients will be selected for annual redetermination reviews.
Recipients identified as being at higher risk for overpayments are
designated as High Error Profile cases and may be subject to more
frequent reviews that entail personal contact with SSA field office
staff. Those recipients identified as being less likely to incur an
overpayment are designated as Medium or Low Error Profile and may only
receive a redetermination conducted by mail rather than in person. Some
Low Error Profile cases are only examined once every 6 years.
[12] The variables used in our model are not an exhaustive list of
potential variables that SSA could use in its risk analysis system.
They represent just a few of the characteristics that were frequently
cited by prior reviews as well as SSA and OIG staff as potentially good
predictors of residency violations.
[13] SSI recipients with residency violations were compared against
recipients with no violations.
[14] SSA data show that, in 1998, refining the case selection
methodology increased estimated overpayment benefits--amounts detected
and future amounts prevented--by $99 million over the prior year. SSA
officials have estimated that conducting substantially more
redetermination reviews would yield hundreds of millions of dollars in
additional overpayment benefits annually. See U.S. General Accounting
Office, Supplemental Security Income: Progress Made in Detecting and
Recovering Overpayments, but Management Attention Should Continue,
GAO-02-849, (Washington, D.C.: Sept. 6, 2002).
[15] Prior GAO reports indicate that monetary penalties and
administrative sanctions may be underutilized in the SSI program. See
GAO-02-849.
[16] See GAO-02-849.
[17] Ibid.
[18] Ibid.
[19] For example, SSA routinely uses information from the Department of
Health and Human Service's National Directory of New Hires to verify
SSI recipients' income.
[20] See Access to Information Held by Financial Institutions, 67 Fed.
Reg. 22021 (now codified at 20 C.F.R. pt. 416).