Articles from prior issues of The Advocate

July/August, 1999

OIG Targets Fraud and Abuse of SSA
by Karen Goodwin, Oregon DDS

PATRICK O’CARROLL, DEPUTY ASSISTANT INSPECTOR General for Investigations, has worked for the Office of Investigations since the establishment of SSA as an independent executive agency in 1995 and has 30 years of federal law enforcement experience. He provided an overview of the duties of the Office of the Inspector General (OIG). Their work is to improve the SSA programs and operations and protect them against fraud, waste and abuse by conducting independent audits, investigations, and evaluations. Their goal is to work cooperatively in partnership with SSA, Congress, and the public for fraud prevention. This is a big responsibility and a great number of federal dollars are at stake. Their limited resources (462 staff) are utilized for prevention and maximizing the effects of their performance audits, investigations and evaluations. As the baby-boomer generation approaches retirement age, SSA must prepare for an unprecedented demand for Social Security benefits. This increase in the volume of work, coupled with a decrease in SSA’s personnel levels, changes in eligibility requirements, and increased emphasis on electronic processing, will inevitably create opportunities for fraud and abuse. Raising the retirement age might lead to more disability fraud as individuals seek methods to stop working at an earlier age. Changes in welfare and immigration policy could increase the use of fraudulent identification to gain access to the workplace or to Supplemental Security Income payments. Further, the Social Security number has become a universally accepted national identifier, and as a result is used to conduct many economic crimes. Finally, the increased use of technology and on-line capabilities has spawned crimes that were unheard of a decade ago. OIG efforts to prevent and detect fraud, waste, and abuse will help ensure that trust fund money is expended only on behalf of individuals who are entitled to benefits. But, their accomplishments are best measured in its dollar return on investment, in other words, what did the taxpayer receive in return for the funds budgeted to OIG. At this point, savings are $5.6 million total, or $50 saved for every dollar invested in the program. The OIG believes that returning funds to the program is more important than convicting those who have received benefits illegally. While that sounds a bit peculiar, here is an example of how it could play out. They gather enough evidence to force someone to return money but it will cost significantly more to do the surveillance needed to obtain a conviction. It is better for the program to get the money and prevent similar fraud or theft than it is to make sure the person goes to jail. The number of allegations that were opened as investigations in 1996 were 1354. In 1998 that number had jumped to 6000. The number of cases closed in 1996 were 1042. By 1998 that number had jumped to 5448. In 1996 there were 507 convictions but by 1998 there were 2762. If you reflect on these numbers, you will note that the OIG is building a backlog based on an ever-increasing workload. (Does this sound familiar to anyone in a DDS?) The investigative activity includes wrongdoing by applicants, beneficiaries, contractors, physicians, interpreters, representative payees, third parties, and by SSA employees in the performance of their duties. Employee fraud accounts for less than one percent, while program fraud accounts for the remainder of their workload.

Examples of violations include: * false statements on claims;

*concealment of material facts or events affecting eligibility;

* misuse of benefits by a representative payee; * false statements to obtain a Social Security Number (SSN);

* misuse of an SSN;

* conflict of interest;

* fraud or misuse of grant or contracting funds;

* significant mismanagement and waste of funds; and

* standards of conduct violations.

While this is not an exhaustive list, it gives you some idea of the types of violations the OIG is investigating. The OIG is looking for trends, identifying patterns of fraud, and utilizing joint operations with other Federal, State and local law enforcement agencies. They are working with the National Crime Information Center to identify and focus on illegal benefit claims by career criminals and fugitives. They are using data base matches to identify and prosecute persons receiving payments made to deceased individuals. OIG faces challenges to refocus their audits by looking for ways to be more proactive at preventing rather than investigating misuse. They want to expand the Hotline availability and use and provide the public with more, better, faster opportunities to report fraud, waste and abuse. If you want to report fraud, think carefully about the allegations and the information available that can help determine whether a crime has been committed then call 1-800-269-0271 or write to SSA Fraud Hotline, P.O. Box 17768, Baltimore, MD 21235, or Fax to 410-597-0118. If you are connected or have access, you can E-mail to oig.hotline@ssa.gov.

FLASH: Oregon is targeted to receive a Special Agent and a fraud office set up in cooperation with the State Attorney General and the local District Attorney.