	Background

The SSI program was established in 1972 under Title XVI of the Social  Security Act and provides payments to low-income aged, blind, and  disabled persons—both adults and children—who meet the financial  eligibility requirements. During fiscal year 2014, SSA estimated that it made  $5.1 billion in improper payments in the program. SSA Faces Program Integrity Challenges in Preventing, Detecting, and Recovering Overpayments

		SSA Could Prevent Billions of Dollars in Overpayments by Conducting More Disability Reviews and Could Ensure Review Consistency by Improving Guidance

Because CDRs are a key mechanism for ensuring continued medical  eligibility, when SSA does not conduct them as scheduled, program  integrity is affected and the potential for overpayments increases as some  recipients may receive benefits for which they are no longer eligible. SSA  reported in January 2014 that it is behind schedule in assessing the  continued medical eligibility of its disability program recipients and has  accumulated a backlog of 1.3 million CDRs. In our June 2012 report, we recommended that SSA eliminate the  existing CDR backlog of cases for children with impairments who are  likely to improve and, on an ongoing basis, conduct CDRs at least every 3  years for these children. If this recommendation were implemented, SSA  could potentially save $3.1 billion over 5 years by preventing  overpayments to children with mental impairments, according to our  analysis of fiscal year 2011 data. Moving forward, one of the goals in SSA’s Fiscal Year 2014- 2018 Strategic Plan is to strengthen the integrity of the agency’s  programs. SSA recently  reported that in each year since 2012, it has increased the number of  reviews conducted for SSI children, completing nearly 90,000 reviews in  fiscal year 2014, in contrast to the 25,000 reviews it completed in fiscal  year 2011, the year prior to GAO’s audit. In prior  work, our analysis of SSA data showed that 1.4 percent of all people  who left the agency’s disability programs between fiscal years 1999 and  2005 did so because SSA found that they had improved medically;  however, recipients more commonly left for other reasons, including  conversion to Social Security retirement benefits or death. In December 2012, we reported that  SSA lacks comprehensive, timely information on SSI recipients’ financial  institution accounts and wages. SSA has developed tools in recent years to obtain more comprehensive  and timely financial information for SSI recipients, but these tools have  limitations:
The Access to Financial Institutions initiative, which SSA implemented  in all states in June 2011, involves electronic searches of about 96  percent of the financial institutions where SSI recipients have a direct  deposit account. SSA recently reported that it is continuing to gain experience using these  tools and is studying the effects of recent expansions to the Access to  Financial Institutions initiative. In May 2015, the SSA Office of the  Inspector General (OIG) noted that despite SSA’s implementation of the  Access to Financial Institutions initiative, the dollar amount of  overpayments associated with financial account information has  increased over the last few fiscal years. The OIG recommended that SSA  continue (1) monitoring Access to Financial Institutions to ensure a  positive return on investment and (2) researching other initiatives that will  help to reduce improper payments in the SSI program. SSA Faces Several Management Challenges in Administering SSI

		SSA Is Taking Some Steps to Address Ongoing Workload and Service Delivery Challenges

SSA faces management challenges that may constrain its ability to  ensure program integrity. During this same time, workloads and service delivery demands  are expected to increase. Federal internal controls guidance states  that management should consider how best to retain valuable employees,  plan for their eventual succession, and ensure continuity of needed skills  and abilities. Thus, we recommended that SSA update its succession  plan to mitigate the potential loss of institutional knowledge and expertise  and help ensure leadership continuity. In response to our  recommendation, SSA published a human capital operating plan,  detailing specific workforce management and succession planning steps  SSA will take across the organization. Federal internal controls guidance states that federal agencies  should comprehensively identify risks, analyze and decide how to  manage these risks, and establish mechanisms to deal with continual  changes in governmental, economic, industry, regulatory, and operating  conditions. We recommended that SSA develop a long-term strategy for  service delivery. In response to these recommendations, SSA appointed a chief strategic  officer responsible for coordinating agency-wide planning efforts. SSA  has also recently taken a key step toward developing a long-range  strategic plan to address wide-ranging management challenges. SSI Program Complexity Is a Long-Standing Challenge

As stated in Vision 2025, SSA plans to realize its service delivery vision in  part by simplifying and streamlining its policies and procedures, and in  2013, SSA formed an SSI Simplification Workgroup that is tasked with  identifying promising proposals that could simplify the SSI program and  reduce improper payments. Program complexity has been a long- standing challenge for SSI that contributes to administrative expenses  and the potential for overpayments.
Why GAO Did This Study

The SSI program, administered by SSA, provides cash assistance to eligible aged, blind, and disabled individuals with limited financial means. In fiscal year 2014, the program paid nearly $56 billion in federally funded benefits to about 8.2 million individuals. The program has grown substantially in recent years, and is expected to grow more in the near future. SSA has a stewardship responsibility to guard against improper payments and to address program integrity issues that if left unchecked could increase the potential for waste, fraud, and abuse. SSA estimated that it made $5.1 billion in improper payments in fiscal year 2014. In addition, SSA's management concerns are wide ranging and include ensuring its workforce is able to meet service delivery needs.
In this statement, GAO describes SSA's challenges with 1) ensuring SSI program integrity and 2) managing the program. This testimony is primarily based on GAO products issued from 2002 to 2015, which used multiple methodologies, including analyses of SSI administrative data from fiscal years 2000 to 2011; reviews of relevant federal laws, regulations, and guidance; and interviews of SSA officials. In May 2015, GAO obtained current data on improper payments and updates from SSA reports and guidance on actions taken to address GAO's past recommendations.

What GAO Found

The Social Security Administration (SSA) faces challenges with ensuring the integrity of the Supplemental Security Income (SSI) program's processes for preventing, detecting, and recovering overpayments. For example, SSA is required in certain circumstances to periodically review SSI recipients' medical and financial eligibility, yet the lack of timely reviews and difficulty getting complete financial information hinder SSA's ability to prevent and detect overpayments to recipients. SSA estimated that $4.2 billion of the payments it administered to SSI recipients in fiscal year 2013 were overpayments. In June 2012, GAO found that SSA had accumulated a substantial backlog of recipients' medical eligibility reviews, including for over 23,000 children with mental impairments who were deemed likely to medically improve when initially determined eligible for benefits. GAO recommended that SSA eliminate its backlog for these children and conduct timely reviews going forward, estimating based on fiscal year 2011 data that these actions could save more than $3.1 billion over 5 years by preventing related overpayments. SSA recently reported that it has increased the number of medical eligibility reviews conducted for SSI children in each year since 2012, completing nearly 90,000 reviews in fiscal year 2014—in contrast to the 25,000 reviews completed in fiscal year 2011—and plans to continue these efforts. In December 2012, GAO also reported that a lack of comprehensive, timely information on SSI recipients' financial accounts and wages led to overpayments. GAO noted that SSA had recently developed electronic tools to address these issues, and SSA reported that the agency is gaining experience using them. However, despite these efforts, in May 2015, the SSA Office of the Inspector General found that overpayments associated with financial account information have increased in recent years and recommended SSA continue researching initiatives that will help to reduce improper payments in the SSI program. SSA agreed to this recommendation.
SSA faces several management challenges in administering SSI related to workload, service delivery, and program complexity. In 2013, GAO reported that as a result of an ongoing retirement wave, SSA faced a loss of institutional knowledge and expertise, which may result in increased review backlogs and improper payments. GAO recommended that SSA update its succession plan, in line with federal internal controls guidance that states that management should plan for succession and ensure continuity of needed skills and abilities. In response, SSA published a human capital document detailing its succession plans. Federal internal controls guidance also states that agencies should comprehensively identify and manage risks, and GAO also recommended SSA develop a long-term service delivery plan to determine, among other things, how SSA will address both program integrity and other workloads. In response, SSA published an April 2015 description of its vision for future service delivery and indicated it plans to develop a strategy for achieving this vision moving forward. SSA also noted the importance of simplifying its policies and procedures to meet its service delivery goals and SSA has plans to do so. Program complexity is a long-standing challenge that contributes to administrative expenses and potential overpayments. GAO is beginning work for this subcommittee related to how benefit amounts are calculated for multiple SSI recipient households, an area that SSA has considered for program simplification.

What GAO Recommends

GAO has previously made recommendations to help SSA strengthen its program oversight and address management challenges. In response, the agency has taken some steps and plans to do more.