publicdata/ssa-gov
1
0
Fork 0
Code Issues Pull requests Projects Releases Packages Wiki Activity Actions
ssa-gov/www.ssa.gov/legislation/testimony_042617.html

440 lines
No EOL
42 KiB
HTML
Raw Permalink Blame History

This file contains ambiguous Unicode characters

This file contains Unicode characters that might be confused with other characters. If you think that this is intentional, you can safely ignore this warning. Use the Escape button to reveal them.

<!doctype html>
<html class="no-js" lang="en">
<head>
<!-- REQUIRED META INFORMATION -->
<meta charset="UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=Edge,chrome=1" />
<meta name="viewport" content="width=device-width" />
<!-- DOCUMENT TITLE -->
<title>Statement of Sean Brune, Assistant Deputy Commissioner for Budget, Finance, Quality, and Management, Social Security Administration, Testimony before the House Committee on Ways and Means, Subcommittee on Social Security</title>
<!-- OCOMM META INFORMATION -->
<meta name="dc.creator" content="OLCA" />
<meta name="lead_content_manager" content="Chris Tino" />
<meta name="coder" content="Gary Davis" /><!-- OCOMM STYLES & SCRIPTS -->
<link href="/framework/css/phoenix.css" rel="stylesheet" media="all" />
<!-- SSA INTERNET HEAD SCRIPTS -->
<script src="/framework/js/ssa.internet.head.js"></script>
<!-- LEGISLATION STYLES -->
<link href="css/legislation.css" type="text/css" rel="stylesheet" media="all" />
<script>(window.BOOMR_mq=window.BOOMR_mq||[]).push(["addVar",{"rua.upush":"false","rua.cpush":"false","rua.upre":"false","rua.cpre":"false","rua.uprl":"false","rua.cprl":"false","rua.cprf":"false","rua.trans":"","rua.cook":"false","rua.ims":"false","rua.ufprl":"false","rua.cfprl":"false","rua.isuxp":"false","rua.texp":"norulematch","rua.ceh":"false","rua.ueh":"false","rua.ieh.st":"0"}]);</script>
<script>!function(e){var n="https://s.go-mpulse.net/boomerang/";if("False"=="True")e.BOOMR_config=e.BOOMR_config||{},e.BOOMR_config.PageParams=e.BOOMR_config.PageParams||{},e.BOOMR_config.PageParams.pci=!0,n="https://s2.go-mpulse.net/boomerang/";if(window.BOOMR_API_key="LERZW-HECFS-R8H4E-23UQ7-ERMQB",function(){function e(){if(!o){var e=document.createElement("script");e.id="boomr-scr-as",e.src=window.BOOMR.url,e.async=!0,i.parentNode.appendChild(e),o=!0}}function t(e){o=!0;var n,t,a,r,d=document,O=window;if(window.BOOMR.snippetMethod=e?"if":"i",t=function(e,n){var t=d.createElement("script");t.id=n||"boomr-if-as",t.src=window.BOOMR.url,BOOMR_lstart=(new Date).getTime(),e=e||d.body,e.appendChild(t)},!window.addEventListener&&window.attachEvent&&navigator.userAgent.match(/MSIE [67]\./))return window.BOOMR.snippetMethod="s",void t(i.parentNode,"boomr-async");a=document.createElement("IFRAME"),a.src="about:blank",a.title="",a.role="presentation",a.loading="eager",r=(a.frameElement||a).style,r.width=0,r.height=0,r.border=0,r.display="none",i.parentNode.appendChild(a);try{O=a.contentWindow,d=O.document.open()}catch(_){n=document.domain,a.src="javascript:var d=document.open();d.domain='"+n+"';void(0);",O=a.contentWindow,d=O.document.open()}if(n)d._boomrl=function(){this.domain=n,t()},d.write("<bo"+"dy onload='document._boomrl();'>");else if(O._boomrl=function(){t()},O.addEventListener)O.addEventListener("load",O._boomrl,!1);else if(O.attachEvent)O.attachEvent("onload",O._boomrl);d.close()}function a(e){window.BOOMR_onload=e&&e.timeStamp||(new Date).getTime()}if(!window.BOOMR||!window.BOOMR.version&&!window.BOOMR.snippetExecuted){window.BOOMR=window.BOOMR||{},window.BOOMR.snippetStart=(new Date).getTime(),window.BOOMR.snippetExecuted=!0,window.BOOMR.snippetVersion=12,window.BOOMR.url=n+"LERZW-HECFS-R8H4E-23UQ7-ERMQB";var i=document.currentScript||document.getElementsByTagName("script")[0],o=!1,r=document.createElement("link");if(r.relList&&"function"==typeof r.relList.supports&&r.relList.supports("preload")&&"as"in r)window.BOOMR.snippetMethod="p",r.href=window.BOOMR.url,r.rel="preload",r.as="script",r.addEventListener("load",e),r.addEventListener("error",function(){t(!0)}),setTimeout(function(){if(!o)t(!0)},3e3),BOOMR_lstart=(new Date).getTime(),i.parentNode.appendChild(r);else t(!1);if(window.addEventListener)window.addEventListener("load",a,!1);else if(window.attachEvent)window.attachEvent("onload",a)}}(),"".length>0)if(e&&"performance"in e&&e.performance&&"function"==typeof e.performance.setResourceTimingBufferSize)e.performance.setResourceTimingBufferSize();!function(){if(BOOMR=e.BOOMR||{},BOOMR.plugins=BOOMR.plugins||{},!BOOMR.plugins.AK){var n=""=="true"?1:0,t="",a="vht6pfix22vgcz6v434q-f-a3ac426ff-clientnsv4-s.akamaihd.net",i="false"=="true"?2:1,o={"ak.v":"39","ak.cp":"1204614","ak.ai":parseInt("728289",10),"ak.ol":"0","ak.cr":3,"ak.ipv":4,"ak.proto":"http/1.1","ak.rid":"45b05","ak.r":35636,"ak.a2":n,"ak.m":"dsca","ak.n":"essl","ak.bpcip":"169.231.231.0","ak.cport":42588,"ak.gh":"23.214.170.79","ak.quicv":"","ak.tlsv":"tls1.3","ak.0rtt":"","ak.0rtt.ed":"","ak.csrc":"-","ak.acc":"bbr","ak.t":"1742071545","ak.ak":"hOBiQwZUYzCg5VSAfCLimQ==avF6FaEZxM1DjDyqI14B2DD0xRlIjH9VXYxcupZ5LGUPIsd74L6bOYi4Lyp7rTh49h7Bi7/JEKMfgKFMGotEbdKL5TqYitE+a6aBO76U3Y0h07mrtc6HLhljYgxP6NDFSan1jjFdUSeDduZ9tPcFur+gkLxbqpV0fWip4YBT6D6HPqT+BYQgrib7VWbiRva/uEOmuKd31XNbxmMycQ7VZXz7ZAoUY0YDenMTUKU1LXJNwbZOLNUJd6pGWOsJAQyGXqZAvrO84HiA39rj0NS+PAXc+3hGSlczZApS5QD/OHoz0nN3/qC25sPtVPODmWaM2TAuRXP5F2miAzAC7z2HZ+GWBNxEa4Qd3N7zNUa0g6edYDciWRS8Ypv4RBT4XTvSMqtpWgBpFetFtiE9StOvakdx2ANSi4JKhsl2NJUwuKA=","ak.pv":"98","ak.dpoabenc":"","ak.tf":i};if(""!==t)o["ak.ruds"]=t;var r={i:!1,av:function(n){var t="http.initiator";if(n&&(!n[t]||"spa_hard"===n[t]))o["ak.feo"]=void 0!==e.aFeoApplied?1:0,BOOMR.addVar(o)},rv:function(){var e=["ak.bpcip","ak.cport","ak.cr","ak.csrc","ak.gh","ak.ipv","ak.m","ak.n","ak.ol","ak.proto","ak.quicv","ak.tlsv","ak.0rtt","ak.0rtt.ed","ak.r","ak.acc","ak.t","ak.tf"];BOOMR.removeVar(e)}};BOOMR.plugins.AK={akVars:o,akDNSPreFetchDomain:a,init:function(){if(!r.i){var e=BOOMR.subscribe;e("before_beacon",r.av,null,null),e("onbeacon",r.rv,null,null),r.i=!0}return this},is_complete:function(){return!0}}}}()}(window);</script></head>
<body id="news">
<p>
<!-- PAGE CONTAINER -->
</p>
<div id="page">
<!-- PAGE HEADER -->
<div class="bg-dark-gray accessibility" id="accessibility"><a id="skip-navigation" href="#content">Skip to main content</a></div><ssa-header class="print-hide"><noscript><header class="banner-neo" id="banner" role="banner" style="background-color: #0b4778;"><div class="banner-wrapper"><h1 class="banner-logo"><a class="banner-logo__link" href="/">Social Security</a></h1><nav class="banner-nav" id="banner-nav"><a class="banner-nav__link banner-search" href="https://search.ssa.gov/search?affiliate=ssa" title="Search" target="_blank"><svg class="banner-nav__icon" focusable="false" width="24" height="24" viewbox="0 0 24 24"><path d="M 10 23 C 11.219 23 12.384 22.762 13.496 22.285 C 14.608 21.808 15.565 21.169 16.367 20.367 C 17.169 19.565 17.808 18.608 18.285 17.496 C 18.762 16.384 19 15.219 19 14 C 19 12.953 18.829 11.951 18.488 10.992 C 18.147 10.033 17.661 9.164 17.031 8.383 L 22.711 2.711 C 22.904 2.518 23 2.281 23 2 C 23 1.713 22.905 1.475 22.715 1.285 C 22.525 1.095 22.287 1 22 1 C 21.719 1 21.482 1.096 21.289 1.289 L 15.617 6.969 C 14.836 6.339 13.966 5.853 13.008 5.512 C 12.05 5.171 11.047 5 10 5 C 8.781 5 7.616 5.238 6.504 5.715 C 5.392 6.192 4.435 6.831 3.633 7.633 C 2.831 8.435 2.192 9.392 1.715 10.504 C 1.238 11.616 1 12.781 1 14 C 1 15.219 1.238 16.384 1.715 17.496 C 2.192 18.608 2.831 19.565 3.633 20.367 C 4.435 21.169 5.392 21.808 6.504 22.285 C 7.616 22.762 8.781 23 10 23 Z M 10 21 C 9.052 21 8.146 20.815 7.281 20.445 C 6.416 20.075 5.672 19.578 5.047 18.953 C 4.422 18.328 3.925 17.584 3.555 16.719 C 3.185 15.854 3 14.948 3 14 C 3 13.052 3.185 12.146 3.555 11.281 C 3.925 10.416 4.422 9.672 5.047 9.047 C 5.672 8.422 6.416 7.925 7.281 7.555 C 8.146 7.185 9.052 7 10 7 C 10.948 7 11.854 7.185 12.719 7.555 C 13.584 7.925 14.328 8.422 14.953 9.047 C 15.578 9.672 16.075 10.416 16.445 11.281 C 16.815 12.146 17 13.052 17 14 C 17 14.948 16.815 15.854 16.445 16.719 C 16.075 17.584 15.578 18.328 14.953 18.953 C 14.328 19.578 13.584 20.075 12.719 20.445 C 11.854 20.815 10.948 21 10 21 Z" transform="matrix(-1, 0, 0, -1, 24.000001, 24.000001)" vector-effect="non-scaling-stroke"></path></svg> <span>Search</span> </a><a class="banner-nav__link banner-menu" href="/menu" id="ssa-menu" title="Menu"><svg class="banner-nav__icon" focusable="false" width="24" height="24" viewbox="0 0 24 24"><path d="M3 5h18q.414 0 .707.293T22 6t-.293.707T21 7H3q-.414 0-.707-.293T2 6t.293-.707T3 5zm0 12h18q.414 0 .707.293T22 18t-.293.707T21 19H3q-.414 0-.707-.293T2 18t.293-.707T3 17zm0-6h18q.414 0 .707.293T22 12t-.293.707T21 13H3q-.414 0-.707-.293T2 12t.293-.707T3 11z" vector-effect="non-scaling-stroke"></path></svg> <span>Menu</span> </a><a class="banner-nav__link banner-languages" href="/es" id="ssa-languages" title="Español" hreflang="es"><svg class="banner-nav__icon" focusable="false" width="24" height="24" viewbox="0 0 24 24"><path d="M12 0C5.373 0 0 5.373 0 12s5.373 12 12 12c.812 0 1.604-.08 2.37-.235-.31-.147-.343-1.255-.037-1.887.34-.703 1.406-2.485.35-3.08-1.053-.6-.76-.868-1.405-1.56-.644-.692-.38-.796-.422-.974-.14-.61.62-1.523.656-1.616.035-.094.035-.446.023-.55-.012-.107-.48-.387-.597-.4-.117-.01-.176.188-.34.2-.164.012-.88-.433-1.03-.55-.154-.117-.224-.398-.435-.61-.21-.212-.235-.047-.562-.175-.327-.13-1.382-.516-2.19-.844-.81-.33-.88-.79-.892-1.114-.012-.325-.492-.797-.718-1.137-.225-.342-.267-.81-.348-.705-.082.106.422 1.336.34 1.37-.083.037-.26-.338-.493-.643-.235-.304.245-.14-.505-1.617-.75-1.476.235-2.23.282-3 .048-.77.633.28.328-.21-.304-.493.023-1.524-.21-1.9-.235-.374-1.57.423-1.57.423.034-.363 1.17-.985 1.99-1.56.82-.573 1.322-.128 1.982.083.66.21.703.142.48-.07-.222-.21.094-.316.61-.235.516.082.656.704 1.442.645.784-.06.08.152.186.35.105.2-.117.177-.633.53-.516.35.012.35.926 1.02.913.667.632-.447.538-.94-.094-.49.668-.105.668-.105.563.375.46.02.87.15.408.13 1.52 1.07 1.52 1.07-1.395.762-.516.844-.282 1.02.235.175-.48.515-.48.515-.294-.293-.34.012-.528.117-.187.105-.012.375-.012.375-.97.153-.75 1.173-.738 1.418.012.247-.62.622-.786.973-.164.35.423 1.113.117 1.16-.305.048-.61-1.148-2.25-.703-.495.134-1.593.703-1.008 1.863.585 1.16 1.558-.328 1.886-.164.33.163-.093.902-.023.913.07.012.927.033.974 1.032.048 1 1.3.914 1.57.938.27.023 1.173-.74 1.3-.774.13-.035.646-.47 1.77.175 1.126.644 1.7.55 2.086.82.387.27.117.81.48.985.365.176 1.818-.058 2.18.54.364.597-1.5 3.597-2.085 3.925-.586.328-.856 1.078-1.442 1.558-.69.563-1.418 1.076-2.18 1.535-.684.407-.807 1.137-1.112 1.367C19.984 22.52 24 17.73 24 12c0-6.627-5.373-12-12-12zm2.813 11.262c-.165.047-.504.352-1.336-.14-.832-.494-1.406-.4-1.477-.48 0 0-.07-.2.293-.236.747-.072 1.688.692 1.9.704.21.012.315-.21.69-.09.375.12.094.195-.07.242zM10.887 1.196c-.082-.06.068-.128.157-.246.05-.07.013-.182.078-.246.175-.177 1.043-.423.874.058-.17.48-.98.527-1.11.434zm2.098 1.523c-.293-.013-.983-.086-.856-.212.494-.492-.188-.633-.61-.668-.423-.036-.598-.27-.388-.294.21-.024 1.055.013 1.196.13.14.117.902.422.95.644.047.223 0 .41-.293.4zm2.542-.083c-.234.188-1.413-.673-1.64-.867-.985-.844-1.513-.563-1.72-.703-.206-.142-.132-.33.184-.61.318-.282 1.21.094 1.724.152.516.058 1.113.457 1.125.93.01.474.562.91.327 1.097z" vector-effect="non-scaling-stroke"></path></svg> <span>Español</span> </a><a class="banner-nav__link banner-signin" href="https://secure.ssa.gov/RIL/SiView.action" id="ssa-signin" title="Sign in" target="_blank"><svg class="banner-nav__icon" focusable="false" width="24" height="24" viewbox="0 0 24 24"><path d="M12 17.016q-.797 0-1.406-.61t-.61-1.405.61-1.405 1.406-.61 1.406.61.61 1.406-.61 1.407-1.406.61zm6 3V9.986H6v10.03h12zm-6-17.11q-1.266 0-2.18.914T8.906 6H9v2.016h6.094V6q0-1.266-.914-2.18T12 2.906zm6 5.11q.797 0 1.406.586t.61 1.383v10.03q0 .798-.61 1.384T18 21.984H6q-.797 0-1.406-.586t-.61-1.384V9.986q0-.798.61-1.384T6 8.016h.984V6q0-2.063 1.477-3.54T12 .985t3.54 1.477T17.015 6v2.016H18z" vector-effect="non-scaling-stroke"></path></svg> <span>Sign in</span></a></nav></div></header></noscript></ssa-header><script src="https://www.ssa.gov/legacy/components/dist/ssa-header.js"></script>
<!-- PAGE NAVIGATION -->
<a class="btn-top-menu show-phone" id="btn-top-menu" href="#nav-top-menu">OLCA MENU</a>
<nav class="nav-top-menu hide-print" id="nav-top-menu" role="navigation">
<ul>
<li><a href="/legislation/index.html">OLCA Home</a></li>
<li><a href="/legislation/118th.html">118th Congress</a></li>
<li><a href="/legislation/priorcongress.html">Prior Sessions of Congress</a></li>
<li><a href="/legislation/resources.html">Program Resources</a></li>
<li><a href="/legislation/other.html">Other Materials for Congress</a></li>
</ul>
</nav>
<!-- PAGE TITLE -->
<div id="title-bar">
<h2>Social Security Testimony Before Congress</h2></div>
<!-- PAGE CONTENT -->
<div id="content" role="main">
<!-- GRID SYSTEM -->
<div class="grid">
<div class="row-12">
<!-- BREADCRUMBS
<div class="column-12">
<ul class="breadcrumb">
<li><a href="home.html">Office of Legislation and Congressional Affairs</a><span class="divider">/</span></li>
<li class="active">News</li>
</ul>
</div>
<div class="clear">&#160;</div>
-->
<!-- NEWS - PAGE 1 -->
<div class="column-12 topic">
<p>&nbsp;</p>
<p align="center"><strong>Statement of Sean Brune, <br>
Assistant Deputy Commissioner for Budget, Finance, Quality, and Management<br>
Social Security Administration<br>
Testimony before the House Committee on Ways and Mean, Subcommittee on Social Security</strong></p>
<p align="center"><strong><br>
April 26, 2017 </strong></p>
<p>Chairman Johnson, Ranking Member Larson, and Members of the Subcommittee:</p>
<p>
Thank you for inviting me to discuss how the Social Security Administration (SSA) takes
seriously our charge to efficiently and effectively detect, deter, and mitigate fraud in the Social
Security programs. I am Sean Brune, the Assistant Deputy Commissioner for Budget, Finance,
Quality, and Management at SSA. We have testified before this Subcommittee several times
about our anti-fraud efforts, and we appreciate your leadership on this important topic over the
years, and your leadership on enacting anti-fraud legislation.</p>
<p> <strong>Background </strong></p>
<p>I would like to provide a brief overview of our programs. We administer the Old-Age,
Survivors, and Disability Insurance (OASDI) program, commonly referred to as “Social
Security.” Individuals earn coverage for Social Security retirement, survivors, and disability
protection and benefits by working and paying Social Security taxes on their earnings. </p>
<p>We also administer the Supplemental Security Income (SSI) program, which provides monthly
payments to people with limited income and resources who are aged, blind, or disabled. Adults
and children under age 18 can receive payments based on disability or blindness. General tax
revenues fund the SSI program. </p>
<p>Few government agencies touch the lives of as many people as we do. Social Security pays
monthly benefits to approximately 62 million individuals, consisting of 42 million retired
workers and 3 million of their spouses and children; 9 million workers with disabilities and 2
million dependents; and 6 million surviving widows and widowers, children, and other
dependents of deceased workers. During fiscal year (FY) 2017, we expect to pay more than
$940 billion to Social Security beneficiaries. In addition, in FY 2017, we expect to pay nearly
$55 billion in Federal benefits to a monthly average of approximately 8 million SSI recipients.
In carrying out these programs, our discretionary administrative costs represent about 1.3 percent
of benefit payments that we paid under the OASDI and SSI programs. </p>
<p><strong>SSA Anti-Fraud Coordination </strong></p>
<p>We can all agree that fraud in any government program degrades the public’s trust in their
government and the integrity of the program. We have no tolerance for fraud. We face the
ongoing challenge of protecting the agency’s benefit programs from fraud. It is despicable that
some people will try to take advantage of our programs, which serve the most vulnerable
members of our society. Nevertheless, we are dedicated to improving our efforts to detect and
prevent fraud, and to deter attempts to defraud the program. Our message to those who attempt
to defraud Social Security is clear: We will find you; we will seek the maximum punishment
under the law; and we will fight to restore the money you have stolen from the American people. </p>
<p>Traditionally, our front line employees have been the first line of defense against fraud in our
programs. These employees are highly skilled and trained to spot anomalies indicative of potential fraud, which they refer to the Office of the Inspector General (OIG) – the agency lead
for combatting fraud – for further investigation. Through this fraud allegation process and other
efforts, the agency has been able to detect a number of fraud schemes in recent years, and has
provided critical support to OIG in its fraud investigations.</p>
<p>That said, we are working to rapidly increase our fraud prevention capabilities. When the agency
testified before this Subcommittee in February 2014, we described our existing efforts and new
initiatives to combat fraud. We take a risk-based approach to reducing fraud, focused first on
mitigating the highest risk issues.</p>
<p>Since that time, we have made a number of organizational, program, and technology-driven changes to
our processes that continue to strengthen our ability to detect attempts to defraud. Today I will
give you an overview of how we have enhanced our anti-fraud efforts since that time, and our
priorities going forward.</p>
<p>In close coordination with OIG, we use a variety of techniques that identify suspected fraud and
help investigators analyze suspicious or questionable claims. We are using data analytics and
employing technology to root out fraud. We have engaged in inter-agency information sharing. For
example, we participated in the Department of Labor, Internal Revenue Service, Supplemental
Nutrition Assistance Program, and Temporary Assistance for Needy Families workgroup to discuss
collaborative solutions to combat fraud schemes that impact multiple programs. We would like to
thank the Government Accountability Office (GAO) for recognizing the progress we have made and our
efforts to establish an organizational culture and structure conducive to fraud risk management. As
GAO notes, our efforts are still evolving.
Yet, we are confident we will make substantial progress to address fraud risks and respond to
emerging risks.</p>
<blockquote>
<p><u>The Office of Anti-Fraud Programs</u></p>
</blockquote>
<p>We have a strong commitment to uphold our responsibility to detect and prevent fraud in our
programs. In 2014, we committed resources to bring renewed focus and prioritize our efforts to
efficiently and effectively detect, deter, and mitigate fraud, waste, and abuse in our programs by
establishing the Office of Anti-Fraud Programs (OAFP). OAFP provides centralized oversight and
accountability for our anti-fraud program. OAFP leads our anti-fraud activities and works across
organizational lines to ensure employees throughout the agency receive training designed to raise
awareness about fraud and have the tools they need to combat fraud. For example, OAFP designs and
implements mandatory national anti-fraud training for employees on a regular basis.</p>
<p>OAFP is an integral component in our efforts to implement the agency Anti-Fraud Strategic Plan.
This plan supports a comprehensive approach to prevent fraud across all of the programs we
administer, including the disability program, and aligns our anti-fraud efforts with the Agency
Strategic Plan and the GAO report, A Framework for Managing Fraud Risks in Federal Programs. The
GAO report identified leading practices for managing fraud risks and identified control activities
to prevent, detect, and respond to fraud in Federal programs. Our agency Anti-Fraud Strategic Plan describes how we are developing and implementing a comprehensive
unified anti-fraud program to align with GAO’s framework. </p>
<blockquote>
<p><u>National Anti-Fraud Committee </u></p>
</blockquote>
<p>We established the current National Anti-Fraud Committee (NAFC) in 2014 to provide a focal
point for our national and regional anti-fraud efforts. The NAFC is a visible demonstration of
our commitment to combating fraud in our programs, and consists of executive members from
all of our Deputy Commissioner-level and agency-level components, as well as the OIG. </p>
<p>The NAFC provides an open forum for agency senior executives to communicate on efforts to
address fraud challenges. The committee evaluates potential anti-fraud initiatives introduced by
the Regional Anti-Fraud Committees, workgroups, and employee suggestions to determine
whether regional projects can and should be expanded or enhanced for national adoption. As we
continue to develop our agency anti-fraud strategy, the NAFC will measure and recommend
necessary corrective action to ensure our initiatives achieve our stated objectives and goals. We
will seek opportunities to prioritize those initiatives and activities through a risk based approach
to mitigating the risk of program fraud. For example, as a result of the NAFC, we have
expanded anti-fraud initiatives that have commenced in one region and expanded them to other
locations. In short, the NAFC works to make sure our agency remains focused on improving our
anti-fraud efforts, and communicates the importance of all employees reporting alleged fraud to
OIG. </p>
<blockquote>
<p><u>Fraud Risk Assessment </u></p>
</blockquote>
<p>Recently, GAO issued an audit report titled <em>SSA Disability Benefits: Comprehensive Strategic
Approach Needed to Enhance Anti-fraud Activities</em>. We agreed with GAO’s recommendations
and are moving forward to integrate those recommendations into our anti-fraud efforts. </p>
<p>GAO recommended that we complete a comprehensive fraud risk assessment of SSA’s disability
program that is consistent with leading practices, and develop a plan to regularly update the
assessment. We will conduct fraud risk assessments on our programs, beginning with the
disability program this fiscal year. For example, we will be reviewing the disability process
from the initial claim through the end of the adjudication process to identify possible
vulnerabilities and determine, through data analysis, whether existing controls mitigate fraud
risk. Based on this assessment, we will develop a fraud risk management strategy for the
disability program that is consistent with leading practices identified in the GAO report, <em>“A
Framework for Managing Fraud Risks in Federal Programs.” </em></p>
<p>GAO recommended we develop, document and implement an anti-fraud strategy that is aligned
with our assessed fraud risks. We will prioritize and align the agency’s anti-fraud strategy to
outcomes of the fraud risk assessment focusing on disability, and the other programs we
administer. We will ensure our fraud risk assessments are consistent with leading practices and
develop a plan for regularly updating the assessments. We will identify and assess risks for
likelihood and impact, and prioritize to address first those risks that yield the highest impact.</p>
<p>GAO recommended we work with components responsible for implementing anti-fraud
initiatives to develop outcome-oriented metrics, including baselines and goals, where
appropriate, for antifraud activities. We are collaborating across all agency components, and
with our OIG, to develop and implement outcome-oriented metrics, including baselines and
goals, where appropriate, for anti-fraud activities. We have already requested input from our
OIG on new metrics that would more effectively measure our progress identifying and reducing
fraud. </p>
<p>GAO recommended we review progress toward meeting goals on a regular basis, and
recommended that the NAFC make changes to control activities or take other corrective actions
to any initiatives that are not meeting goals. </p>
<p>As we identify new fraud risks, we will develop
new anti-fraud activities to reduce and prevent fraud in the disability program. The NAFC will
make changes to internal control activities or take other corrective actions to any initiatives that
are not meeting goals.
We believe that integrating GAO’s recommendations will further align our anti-fraud program
with GAO’s framework for managing fraud risks. </p>
<p><strong>SSA Anti-Fraud Efforts</strong></p>
<p>Fighting fraud is a multi-faceted effort, which is reflected in the tools we already use to fight
fraud. Our anti-fraud efforts cover all Social Security programs, including disability, retirement
and survivors, and enumeration. Below, I provide examples of our anti-fraud efforts relating to
our disability programs. </p>
<blockquote>
<p><u>Employees on the Front Lines of Fighting Fraud</u></p>
</blockquote>
<p>In all of our anti-fraud efforts, our front-line employees remain an important line of defense in
detecting and preventing fraud, and we remain committed to improving our anti-fraud training
for these employees. Since 2014, we have required anti-fraud training for all agency and
disability determination services (DDS) employees. The annual mandatory national anti-fraud
training ensures employees remain informed on the current and proper means to support the
agency’s efforts to detect and prevent fraud. When our field office employees and State
disability examiners uncover potential fraud, we instruct them to report all fraud allegations to
the OIG Office of Investigations Field Division using the electronic referral form. Our
employees prevent fraud by promptly referring allegations to OIG for investigation, and assisting
OIG by developing case information for fraud investigations. On average, our employees refer
around 20,000 allegations relating to disability to OIG each year, more than what the OIG
receives from all other sources. We also provide ad hoc training related to handling claims
associated with third party facilitator disability fraud (including fraud schemes involving
claimants’ representatives, physicians, or government employees). While detecting fraud is not
new to the agency, this mandatory training provides an overview of SSA’s anti-fraud fighting
efforts and strategies for identifying and reporting potential fraud.</p>
<blockquote>
<p><u>Fraud Prevention Units </u></p>
</blockquote>
<p>As part of the agency’s focus on anti-fraud initiatives, we established Fraud Prevention Units
(FPU) in 2014. FPUs are specialized fraud units of disability examiners dedicated to evaluate
and act on probable fraud cases perpetrated through third party facilitators. FPU examiners also
compile data from the cases to help us further develop analytical tools to identify potential fraud.</p>
<p> Moreover, our employees in the FPUs serve a critical role in assisting OIG with its investigations
and prosecutions of fraud cases. Our analysts conduct research, analyze, and evaluate
information to support fraud investigations. They also develop recommendations for improving
operational policy, procedures, and internal controls to prevent the recurrence of fraud. Through
their review of medical documentation and evidence, we have identified a variety of different
“potential fraud” scenarios. Examples include, but are not limited to, attorneys who rely on
altered or fabricated medical opinions; psychiatrists who prepare template-style medical records,
generic wording, exaggerated symptoms and limitations; and potentially fabricated medical
records that clearly conflict with other medical sources in file. </p>
<blockquote>
<p><u>Special Assistant United States Attorneys Fraud Prosecution Project </u></p>
</blockquote>
<p>For more than a decade, in partnership with the Department of Justice (DOJ), we have placed a
number of attorneys from our Office of the General Counsel in several United States Attorney’s
Offices around the country to bring Federal criminal charges against individuals who defraud
Social Security programs. These Special Assistant United States Attorneys (SAUSAs) have a
focus and commitment to seek the maximum punishment under the law for all persons who
defraud Social Security. These attorneys are dedicated to Social Security fraud cases and have
increased the number of prosecutions of violations of the Social Security Act. They obtain
criminal sanctions, including imprisonment, and recover funds for the agency through criminal
restitution and forfeiture. For example, SSA’s fraud prosecutors in the U.S. Attorney’s Office
for the District of Puerto Rico were involved in prosecuting the case against third-party fraud
facilitators involving a disability fraud scheme. </p>
<p>The fraud prosecution project produces good outcomes. Since FY 2003, our fraud prosecutors
have secured over $60 million in restitution and more than 1,000 convictions. During the first
half of FY 2017, our SAUSAs successfully obtained at least 119 guilty pleas and convictions.
This led to over $10.3 million in restitution, including more than $6.3 million in restitution to
SSA. We are committed to maintaining our prior level of commitment with the SAUSA
program. </p>
<blockquote>
<p><u>Anti-Fraud Communications </u></p>
</blockquote>
<p>Our anti-fraud prevention efforts also involve communicating with the public about fraud,
including communications with our beneficiaries and claimants. We are telling our customers,
our employees, and the public at large, through multiple channels, that fraud is not tolerated and
will be investigated and prosecuted. Since 2014, we have added language in millions of the
notices we send to beneficiaries and claimants telling them to report any suspected fraud to our
OIG and include the OIG fraud website and Fraud Hotline phone number. In addition, on our applications, and our redetermination and continuing disability review forms, we inform
individuals that they provided information to us under penalty of perjury and that they could be
liable under law for providing false information. </p>
<p>Further, our anti-fraud communications go beyond these direct communications with
beneficiaries and claimants. For example, on a regular basis, we publish Social Security blog
posts informing the public about our anti-fraud efforts across our programs. Our public affairs
specialists across the country regularly interact with groups, organizations, and individuals to
promote our anti-fraud messaging and to provide such groups with SSA fact sheets, posters, and
other information that promote our strong anti-fraud message. Our website also contains
information on how to report suspected fraud and examples of what we are doing to combat
fraud. </p>
<p>We also communicate regularly with our employees regarding their responsibility to refer all
suspected fraud to the OIG for full investigation. At the national, regional and local levels, the
OIG provides ongoing feedback to the agency on successful fraud prosecutions resulting from
allegations referred by our employees. </p>
<blockquote>
<p><u>Anti-Fraud Data Analytics </u></p>
</blockquote>
<p>In addition to our commitment to engaging in fraud risk assessments, we continue to review
national data for trends and fact patterns that suggest fraudulent activity. The use of data
analytics enhances our fraud prevention and allows us to develop analytical tools to determine
common characteristics and patterns of fraud. In addition to the fraud referrals initiated by our
employees, we use these automated tools to help us uncover potential fraud or other suspicious
behavior in the programs we administer. Since 2013, we have successfully applied data analytics
to identify and prevent fraudulent activity in the electronic services business process. As we
continue to expand our use of data analytics and technology to detect and prevent disability
fraud, we are expanding on the use of predictive modeling to determine common characteristics
and patterns of anomalous behavior based on known cases of fraud. We have completed proofs
of concept using case characteristics identified in the New York and Puerto Rico conspiracies to
help build new analytical models and to determine if those characteristics could identify
potentially fraudulent transactions in other localities. </p>
<p>An important initiative in enhancing our analytic capabilities to prevent fraud is the Anti-Fraud
Enterprise Solution (AFES). The AFES will allow the agency to more accurately identify and
take action on more difficult-to-identify high-risk transactions across our programs and
processes, including disability, electronic services, retirement, SSI, and internal employee
systems. Notably, in disability cases, the AFES will help the agency to stop fraudulent
transactions before payments are made. AFES will include five key features of anti-fraud
management into our business process: 1) data analytics, 2) incident management, 3) workflow
management, 4) systems communications, and 5) business intelligence. This integrated system
will provide a uniform platform and infrastructure for advanced data analytics. It will also
modernize our case management and workflow capabilities to allow OIG to conduct more
efficient and timely inquiries and investigations of possible fraud incidents as we identify them.
Ultimately, AFES will also enhance our ability to make data-driven anti-fraud decisions and better inform stakeholders, such as this Subcommittee and the public, on the progress of our antifraud
efforts. </p>
<p>As part of the AFES development strategy, in December 2016 we procured IBM’s Counter
Fraud Management software and have recently installed this software on our systems
infrastructure. We will run the software in real-time as claims, including disability claims, are
processed in order to prevent fraud by referring suspicious claims for OIG investigation before
adjudication. AFES will assess all claims to identify situations that appear to be similar to
known fraud schemes or are otherwise considered to be high-risk. Trained employees in
centralized units will review claims that raise flags before we authorize payments. The software
will become more effective over time; as we identify new suspicious or fraud trends, we will
continuously improve the ability of the software to identify such trends when reviewing claims. </p>
<p>One of the first applications that will benefit from the AFES systems incident management,
workflow management, and systems communications features is the redesign of the electronic
form that employees use to refer potential program violations to OIG for further investigation.
As described above, currently our employees use an online electronic referral form, to report
fraud allegations to the OIG. Integrating the fraud referral form into AFES will enhance our
ability to identify interrelated claims and high-risk transactions across our programs. It will also
modernize our workflow capabilities and assist OIG in conducting more efficient and timely
inquiries and investigations of possible fraud. Integrating the fraud referral form into AFES will
provide data to enhance our models quickly and make data-driven anti-fraud decisions. Lastly,
the redesign of the fraud referral form will better position SSA to comply with the<em> Fraud
Reduction and Data Analytics Act of 2015. </em></p>
<p>AFES is a multi-year, multi-phase effort that will replace and expand OAFP’s current anti-fraud
systems, processes, and models. The agency will use the outcome of the fraud risk assessment
on disability to form our strategy to implement new analytical models to prevent fraud in the
disability program. Future phases will follow in subsequent years to include all of the agency’s
service delivery processes. </p>
<p><strong>SSA Anti-Fraud Efforts Strengthened by New Legislative Provisions </strong></p>
<p>In addition to the steps we have taken to increase our anti-fraud capabilities, recently legislation
has included provisions that enhanced and strengthened our on-going anti-fraud efforts.</p>
<blockquote>
<p> <u>Cooperative Disability Investigations Units</u></p>
</blockquote>
<p>The Cooperative Disability Investigations (CDI) Program is a key anti-fraud initiative that plays
a vital role in combating fraud and abuse within our disability programs. Chairman Johnson, and
this Subcommittee, have long championed the CDI program, and we thank you for that support.
Importantly, the CDI units prevent benefit payments from being made in cases involving fraud.
CDI units consist of personnel from SSA, OIG, State DDSs, and state/local law enforcement, and
they review initial disability claims and post-entitlement activities when our front-line employees
suspect possible fraud. CDI units obtain evidence of material fact to resolve questions of fraud.</p>
<p>States and Territories no later than October 1, 2022, subject to the availability of funding and
participation of local law enforcement agencies. Currently, the CDI Program consists of 39 units
that cover 33 states, the Commonwealth of Puerto Rico, and the District of Columbia. With
available agency funding and participation from local law enforcement, we will expand the
number of CDI units needed to cover the 17 remaining States (and remaining Territories). We
are currently slated to open one CDI unit in FY 2017, and will target implementation of two to
four units per year thereafter until nationwide coverage is complete. </p>
<p>During FY 2016, the CDI program reported approximately $268 million in projected savings to
SSA’s disability programs and approximately $323 million to non-SSA programs, such as
Medicare, Medicaid, housing assistance, and nutrition assistance programs. Moreover, since the
program launched in FY 1998 through September 2016, CDI efforts contributed to
approximately $3.5 billion in projected savings to SSA’s programs, and approximately $2.4
billion in projected savings to non-SSA programs. </p>
<blockquote>
<p><u>Exclusion of Certain Medical Sources of Evidence </u></p>
</blockquote>
<p>In addition, we appreciate the leadership of Chairman Johnson, and this Subcommittee, in
bringing greater focus on excluding tainted medical evidence. Chairman Johnson introduced a
provision – now law – that provides that unless we find good cause to do so under our rules, we
will not consider evidence furnished by medical sources convicted of certain felonies, excluded
from participation in Federal health care programs, or assessed with a CMP, assessment, or both,
for submitting false evidence.<tt><strong>1</strong></tt> It ensures that we continue to make our disability determination
decisions based on the best available evidence from trustworthy medical sources. </p>
<p>To implement this provision, we published a final rule that was effective November 2, 2016 that
requires excluded medical sources of evidence to inform us in writing of their exclusion(s) each
time they submit evidence to us that relates to a claim for Social Security disability benefits or
payments. For those sources who do not inform us of their excluded status, where appropriate,
we will refer them to our OIG for any action it deems appropriate, including investigation and
CMP pursuit. Moreover, prior to effectuating an allowance where a disability examiner has
evaluated evidence under recent legislation, the case must first be sent to our quality component
to ensure proper application of such legislation. We are also working to add automated matching
to identify these sources and their evidence. </p>
<blockquote>
<p><u>New and Stronger Civil Monetary Penalties</u></p>
</blockquote>
<p>People, including third party facilitators, who commit fraud against our programs may be
assessed civil monetary penalties for their actions, as well. Recent legislation also increased the
penalty for conspiracy to commit Social Security fraud and certain offenses committed by people
who violate positions of trust, such as doctors and lawyers submitting false medical evidence,
and current and former Social Security employees. </p>
<p><strong>Conclusion</strong></p>
<p>As good stewards of our resources and the Social Security Trust Funds, and SSI program dollars,
it is our duty to work aggressively to prevent and detect fraud and recover the overpayments
from the fraud. We have a comprehensive and integrated anti-fraud program. We are working
to increase prevention through advanced predictive analytics. We will continue to measure our
progress. </p>
<p>We appreciate this Subcommittee’s assistance in these efforts and stand ready to work with
Congress to maintain the public’s trust and confidence in our very important social insurance
programs. We also appreciate GAO’s comprehensive review and analysis of our work in this
area, and look forward to implementing GAO’s helpful recommendations as we embark on a
fraud risk assessment analysis of our disability programs. </p>
<p>As a critical reminder, everyone can play a key role in protecting his or her investment in Social
Security. When members of the public suspect fraud, we ask that they report it to OIG. OIG
evaluates every allegation of fraud and, for those cases where it determines fraud has occurred,
aggressively pursues the case. It is easy to report fraud online by visiting OIG’s<em> Fraud, Waste,
and Abuse</em> page at <a href="http://oig.ssa.gov/report" target="_blank">http://oig.ssa.gov/report</a>, or by telephone through OIG’s Social Security Fraud
Hotline at 1-800-269-0271.</p>
<p><strong>______________________________________________________________________</strong></p>
<p><strong>1</strong> GAO had previously recommended that “[t]o address the potential risks associated with medical evidence
submitted by sanctioned physicians, SSA should evaluate the threat posed by this information and, if warranted,
consider changes to its policies and procedures.” See GAO-15-19, SSA Disability Benefits: Enhanced Policies and
Management Focus Needed to Address Potential Physician-Assisted Fraud (Nov. 2015). We would note that section
812 of the Bipartisan Budget Act of 2015, which generally prohibits consideration of evidence by sanctioned
medical providers, addresses the GAO recommendation.</p>
<p>&nbsp;</p>
</div>
</div><!-- end .row-12 -->
</div><!-- end grid -->
</div>
<p align="center">&nbsp;</p>
</div>
<!-- end #page -->
<!-- OCOMM BODY CONTENT -->
<!-- SSA INTERNET BODY SCRIPTS -->
<script src="/framework/js/ssa.internet.body.js"></script>
</body>
</html>
Reference in a new issue View git blame Copy permalink