In addition, RRB administers Medicare coverage  for railroad workers. Occupational disability is a unique benefit for railroad workers. Continuing Disability Reviews

Federal law generally requires RRB to conduct CDRs to determine if  beneficiaries continue to meet the disability requirements of the law. For MINE  cases, RRB’s regulations state that it will not routinely review the  beneficiary’s continuing eligibility. 1.) Earnings Continuing Disability Reviews

In addition to medical reviews, RRB conducts earnings CDRs for  beneficiaries detected with earnings that exceed disability program  limits. 2.) 2.) Most Beneficiaries Are Not Subject to Medical CDRs, and Data Used to Identify Unreported Earnings and Potential Overpayments Are Outdated

		RRB Completed CDRs for Slightly More Than 1 Percent of Disability Beneficiaries in Fiscal Years 2014-2016

Over the 3 years for which RRB was able to provide us with complete  data, the agency completed 427 CDRs. This number represents CDRs  for slightly more than 1 percent of the railroad workers who received  disability benefits during that period, an average of about 35,000,  including both occupational and T&P beneficiaries. Data provided by RRB indicate that of the 43 medical  CDRs completed during fiscal years 2014-2016, 3 ineligible beneficiaries  were identified and 1 overpayment of $28,000 was identified and  calculated. RRB Developed Criteria for Conducting Additional Medical CDRs to Target Cases at Risk for Fraud, but These CDRs Identified No Ineligible Beneficiaries in Two Years

In fiscal year 2015, RRB expanded the use of medical CDRs to include  certain high-risk occupational disability cases that would previously only  have been selected for a CDR if RRB received a report of medical  recovery or identified earnings that could affect entitlement to benefits. During  this same time period, earnings CDRs identified at least $970,550 in  overpayments that had been calculated for CDRs completed during fiscal  years 2014-2016. Providing RRB with similar access to more recent earnings data would  enable it to identify potential overpayments sooner than is currently  possible. RRB’s Oversight of Its CDR Program Has Focused on High- Risk Reviews Rather Than Overall Program Data

		RRB Has Reviewed High- Risk CDRs, but Outcomes Call This Effort into Question

RRB’s Program Evaluation and Management Services (PEMS), which is  tasked with conducting reviews to ensure efficient program performance,  has conducted two internal reviews of the high-risk medical CDRs since  they were first implemented in 2015. RRB  officials said compiling comprehensive information for the CDR program  can be challenging because CDR data are housed in multiple systems,  some of which use outdated software and are not compatible with each  other. RRB was able to compile data  for fiscal years 2014-2016 for our review that made it possible for us to  analyze different aspects of the CDR program, such as the number of  medical and earnings CDRs completed each year, the amount of  overpayments identified as a result of CDRs, and CDR outcomes. If RRB routinely compiled and  analyzed these data for its own purposes, it could better monitor CDR  program performance. Routinely compiling and analyzing CDR program data would also allow  RRB to identify potential gaps in oversight. Without these data, RRB cannot  anticipate how many medical CDRs it should expect to conduct and  when. In its fiscal year 2017 Performance and  Accountability Report, RRB reported a return on investment of $4.18 for  each dollar spent on combined program integrity efforts in fiscal year  2016. RRB’s lack of routine data collection and analysis hampers its ability to  monitor program performance and determine what changes, if any,  should be made to improve the CDR program, including determining the  number of beneficiaries in each medical improvement category and the  costs and benefits of conducting the various types of reviews. Matter for Congressional Consideration

To improve RRB’s ability to make accurate disability benefit eligibility  determinations, including CDRs, and to decrease the potential for making  improper payments, Congress should consider granting RRB access to  the Department of Health and Human Services’ quarterly earnings  information from the National Directory of New Hires database. According to RRB data, the value of Trust-managed  assets at the end of fiscal year 2016 was $25.1 billion. GAO-14-418.
Why GAO Did This Study

RRB is an independent agency that administers disability benefits for railroad workers. In fiscal year 2016, about 31,000 railroad workers with disabilities received $1.1 billion in disability benefits. RRB is generally required to periodically assess beneficiaries' medical condition or earnings through continuing disability reviews (CDRs) to verify that they remain eligible for disability benefits.
This report examines the extent to which RRB (1) conducts medical and earnings CDRs to ensure the continued eligibility of disability beneficiaries, and (2) oversees the CDR program. GAO analyzed data provided by RRB for CDRs completed in fiscal years 2014-2016, the only years for which complete data were available. GAO also reviewed RRB's policies and procedures, a nongeneralizable random sample of 14 CDR cases that were completed in fiscal year 2016, and relevant federal laws and regulations; and interviewed RRB officials.

What GAO Found

In fiscal years 2014-2016, the Railroad Retirement Board (RRB) completed continuing disability reviews (CDRs) of various types for 427 beneficiaries (see figure below), covering slightly more than 1 percent of the railroad workers who received disability benefits during that period. These reviews included:
Scheduled Medical Reviews –These are scheduled at different intervals depending on the likelihood of medical improvement. RRB data suggest that most beneficiaries are not subject to these CDRs because they are older than 54½, which RRB defines as the age at which they are unlikely to return to work. Of 43 medical CDRs that were scheduled, RRB identified 3 ineligible beneficiaries and 1 overpayment of about $28,000.
High-Risk Reviews – In fiscal year 2015, RRB began conducting medical CDRs on cases it considered to be at high risk for fraud. It completed 166 of these reviews in fiscal years 2015 and 2016, but none identified any ineligible beneficiaries or overpayments.
Earnings Reviews – During fiscal years 2014-2016, 163 earnings CDRs identified 47 ineligible beneficiaries and at least $970,550 in overpayments. However, RRB uses earnings information that can be up to 2 years old, thereby delaying the detection of ineligible beneficiaries and increasing the potential for lost federal dollars. Other federal agencies have access to a national federal database with more recent earnings data. Providing RRB access to these data would enable it to identify overpayments sooner.
Medical + Earnings Reviews – In some cases, RRB conducts both a medical and earnings CDR. RRB's data do not allow GAO to attribute the outcome to either type of CDR.
RRB oversight has primarily been limited to conducting two internal reviews of high-risk medical CDRs, one of which concluded, consistent with the above results, that these CDRs demonstrated no return on investment. Nevertheless, RRB continues to do them. RRB does not routinely compile and analyze data for all of the CDRs it conducts, which limits its ability to identify potential gaps in oversight and to monitor program performance. For example, RRB lacks data that would help it determine how many medical CDRs it should expect to conduct. RRB officials said compiling data can be challenging because it uses multiple data systems. However, by more efficiently collecting and compiling key CDR data, RRB could enhance its capability to routinely assess program performance.

What GAO Recommends

Congress should consider giving RRB access to the National Directory of New Hires, a national database of wage and employment information that would enable it to identify potential overpayments sooner. GAO is also making three recommendations to RRB, including that it reconsider the purpose and value of high-risk CDRs, and routinely compile and analyze CDR data to improve oversight. RRB agreed with these recommendations.