PRIVATE SECTOR PAYMENT RECAPTURE AUDIT TECHNIQUES

Corrections are made to the amount of benefit overpayments made in FY 2009 to Old Age, Survivors and Disability Insurance (OSDI) program and to the Supplemental Security Income (SSI) program referenced in the original RFI. The corrections are underlined and italicized in the MODIFIED RFI below. No other information in the RFI is affected by these changes. The Social Security Administration (SSA) is interested in seeking information about the type of cutting-edge technology and tools the private sector is using to identify benefit overpayments. We will be using this information to compare to SSA's current payment recapture audit system. Accordingly, submitted recovery audit innovations should not duplicate SSA's existing audits, in-house payment recapture processes, or planned process improvements (see the SSA improper payment website and our Performance and Accountability (PAR) report for a comprehensive explanation of our current practices and planned initiatives.) The description for SSA's current in-house payment recapture processes are described in detail in the following paragraphs. As currently defined in the OMB guidance, "Payment recapture audits are investigations in which specialized auditors (oftentimes private sector auditors) use cutting edge technology and tools to scrutinize government payments and then find and reclaim taxpayer funds made in error or gained through fraud." At the SSA, we make benefit payments under the Old Age, Survivors and Disability Insurance (OASDI) and the Supplemental Security Income (SSI) programs. The OASI program provides monthly benefits to retired workers, their spouses, and minor children. In the event of death, we pay survivors benefits to the deceased's family. The DI program pays benefits to individuals who cannot work because they have a medical condition that precludes them from performing work in the national economy and expected to last at least one year or result in death. We also pay dependent benefits to the spouse and minor children of the disabled individual. In FY 2009, we paid $659 billion in OASDI benefits to approximately 53 million beneficiaries. About $2.5 billion or 0 .4 percent of the benefits were overpayments. The SSI program is a means-tested program for elderly individuals, as well as blind or disabled adults and children, who have limited income and resources. SSI is a complex program to administer because eligibility and monthly payment amounts are highly sensitive to fluctuations in monthly income, resources, and living arrangements. Improper payments can occur if recipients, or their representative payees, fail to timely report changes in any of these factors; e.g., a change in their resources or an increase or decrease in wages. Failure to report these payment-affecting changes is the primary cause for both overpayment and underpayment errors and has been a perennial problem since the inception of the SSI program. In FY 2009, we paid $48.3 billion in SSI benefits to almost 7.7 million recipients. About $4 billion or about 8.4 percent were overpayments. A variety of organizations reviews OASDI and SSI payment accuracy. Our Office of Quality Performance performs stewardship reviews, which measure the accuracy of payments to beneficiaries and recipients. Each month we review a sample of OASDI and SSI cases to determine payment accuracy rates. For each sample case, we interview the beneficiary, recipient, or representative payee, make collateral contacts as needed, and redevelop all nonmedical factors of eligibility and payment amount for the review period that affects the sample month. We use this data to identify payment accuracy strengths and weaknesses. We use internal staff to conduct ongoing eligibility. Medical Continuing Disability Reviews (CDR) are periodic reevaluations to determine if beneficiaries are still disabled. A work CDR is a review of the eligibility requirements regarding a DI beneficiary's earnings or his or her ability to perform substantial gainful employment. SSI redeterminations are periodic reviews of nonmedical factors of eligibility, such as income and resources. CDRs and redeterminations are extremely effective at identifying cases where benefits should be discontinued. To help us identify overpayments and underpayments and prevent their recurrence, we rely on stewardship reviews. For example, these reviews identified the major (root) causes of overpayments in the OASDI program to be verification and local administrative errors such as: (1) substantial gainful employment that occurs when a disability beneficiary starts work; (2) when we are not notified of a spouse or surviving spouse who receives a monthly pension from a Federal, state or local government agency based on their own work not covered by Social Security; or (3) when posted earnings on SSA records are found to be erroneous. Our major causes of overpayments in the SSI program are: (1) financial accounts that exceed the allowable resource limits; (2) wages that exceed the wage amount used to calculate a payment; and (3) in-kind support and maintenance in the form of food and shelter that is more than the amount used to calculate the payment. Our improper payments web site at www.ssa.gov/improperpayments, features additional information about our efforts to identify and eliminate root causes of payment error. Our FY 2010 PAR website at http://ssa.gov/finance/ contains additional detailed information about the types of payments we make and the tools we use to reduce improper payments. Responses to this Request for Information should be limited to specific tools and technology that exist. We are interested in succinct responses no longer than one page per tool or technology. Responses should not include brochures on company profiles or sales presentations, but should include a list of Federal or State agencies that are currently using the tools or technology identified in the one-page responses. Our goal is to determine whether it is feasible to solicit for private sector payment recapture audit services that we do not currently perform. Responses are due eight days from the date of this Request for Information (RFI), i.e.December 15, 2010. This is for market research purposes only. SSA will not be responding to any submitters, unless additional information or clarification is required. The Government does not intend to pay for information provided in response to this publication. Respondents should refer to MMY-AUDIT SERVICES.