The Department of Health and Human Services (HHS) Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded health care programs and maintains the List of Excluded Individuals and Entities —a list of all excluded individuals and entities, also known as sanctioned medical providers (SMP). On October 3, 2012, Social Security Administration’s (SSA) Office of Disability Programs asked us to review SMPs in SSA’s medical evidence of record (MER) files.
Improve the Timeliness and Quality of the Disability Process
Disability determination services (DDS) in each State or other responsible jurisdiction perform disability determinations under the Social Security Administration’s (SSA) Disability Insurance and Supplemental Security Income programs according to Federal law and regulations. Each DDS is responsible for determining claimants’ disabilities and ensuring adequate evidence is available to support its determinations.
Our objective was to answer specific questions from the Subcommittee on Social Security regarding the Social Security Administration’s (SSA) Disability Research Consortium (DRC) grants. The DRC is designed to establish a disability research program that meets SSA’s growing need for research-based information on matters related to program and public policy.
Self-employed individuals annually report self-employment income (SEI) to the Internal Revenue Service. The IRS then provides the Social Security Administration this SEI information, which is posted to SSA’s Master Earnings File and used to determine eligibility for retirement, survivors, disability, and health insurance benefits as well as to calculate benefit amounts.
In this review, we (1) evaluated the Georgia Disability Adjudication Services’ (GA-DAS) internal controls over the accounting and reporting of personnel costs; (2) determined whether the personnel costs claimed by GA-DAS were accurate and allowable, and funds were properly drawn for these costs; and (3) determined whether GA-DAS complied with SSA policies, procedures, and guidelines when hiring personnel.
SSA conducts continuing disability reviews (CDRs) on Disability Insurance beneficiaries and SSI recipients to determine whether they remain medically eligible for disability payments. A decision to discontinue benefits is made when a CDR reveals the individual no longer meets the medical requirements of disability benefits, referred to as medical cessation determinations. SSA should inform the individual of its decision and discontinue payments two months after the cessation determination.
This audit sought to determine whether administrative costs claimed were valid, supported, and accurately reported; indirect costs were valid and allowable; and Puerto Rico's Disability Determination Program's parent agency established a timeframe for resuming full responsibility for the issuance of administrative expense-related payments.