Why Social Security’s Crackdown on Disability Fraud Is Coming Up Short
Policy + Politics

Why Social Security’s Crackdown on Disability Fraud Is Coming Up Short


The Social Security Administration is falling well short of its potential to weed out waste and fraud in the Disability Insurance program at a time of mounting concern about the costly program’s financial underpinnings, according to a new study by the Government Accountability Office (GAO). 

While the Social Security Administration does ferret out cases of beneficiaries who no longer qualify for physical or mental disability benefits, a GAO study released last week concludes that SSA does not review cases in a manner that maximizes potential savings — cases that often see costs climb into the hundreds of millions of dollars. 

Related: A Cautionary Tale About the Latest Effort to Cut Disability Insurance Benefits 

For example, the estimated average savings from conducting some of these reviews are higher for some groups of beneficiaries than others, yet the SAA selection process doesn’t distinguish between those groups. “As a result, it may be missing opportunities to efficiently and effectively use federal resources,” the report states.

What’s more, for a variety of factors including inadequate funding, the backlog of continuing disability reviews totaled 900,000 by the end of fiscal 2014, even while timely reviews “are an important check on the integrity of the disability programs and have consistently saved the government more money than they cost to conduct.” This has been a persistent problem at the SSA for years, dating back to fiscal 2002 when special funding authority for the reviews expired. The backlog almost immediately skyrocketed from about 100,000 cases in fiscal 2003 to a peak of nearly 1.5 million in 2009 before subsiding. 

While SSA has an extensive process for reviewing the quality of continuing disability review decisions and a high overall accuracy rate, “Until the agency systematically uses available data to identify error-prone cases and root causes, it will be hard-pressed to prevent similar errors from recurring,” according to the report. “In addition, absent tracking all meaningful errors that it identifies, such as date errors, the agency and other stakeholders lack an accurate sense of the true error rate of CDRs.” 

The $150 billion Disability Insurance trust fund, which recently received a bailout from Congress to avert a cash flow crisis, provides monthly benefits to individuals who are unable to work because of severe long-term physical or mental disabilities. The means-tested program provides financial assistance to disabled, blind or elderly individuals, as well as low-birthweight babies. Republican critics of the program have long complained about fraud in the program. And the GAO reported in 2012 that hundreds of thousands of reviews of childhood disabilities were more than three-years behind schedule — including children who were expected to improve medically and no longer require coverage.

Related: Audit Uncovers $124.7 B of Overpayments and Fraud in Medicare and Medicaid

Under federal law, SSA is generally required to conduct status reviews for infants during their first year of life if they are receiving benefits related to low birth weight, and at least once every three years for children under the age of 18 if their physical problems are considered likely to improve. The agency is also is required to review the cases of all SSI children beginning on their 18th birthday to determine whether they are eligible to claim benefits under adult disability criteria.

The study was requested by two senior Republicans on the House Ways and Means Committee, Rep. Vern Buchanan of Florida and Rep. Sam Johnson of Texas. 

The GAO offered a series of recommendations, including directing the Deputy Commissioner of Operations to further consider cost savings “as part of its prioritization of full medical reviews,” and ordering the Deputy Commissioner of Budget, Finance, Quality and Management to complete a re-estimation of the statistical models used to prioritize the continuing disability reviews.

With growing concern over potentially billions of dollars of Social Security fraud in recent years — from phony disability insurance claims to retirement payments for deceased beneficiaries — Congress late last year approved a major crackdown that includes harsher criminal and civil penalties and fines.

Related: New Evidence That Disability Fraud Costs Billions

The reforms include the promulgation of a new felony specifically for conspiracy to commit Social Security fraud that is punishable by up to five years in prison and fines of up to $250,000. The reforms would also impose much tougher penalties of from five to 10 years in prison for individuals in positions of trust, such as claimant representatives, doctors and other health care providers or current or former employees of the Social Security Administration. Disability insurance recipients could also lose their benefits if they are found to have been concealing work activity or misrepresenting their physical or mental conditions.

The new penalties were included in a bipartisan omnibus budget and debt ceiling agreement that also included measures to bolster the sagging revenues in the Social Security Disability Insurance program and prevent a 20 percent, across-the-board cut in benefits for 11 million people.