Improving the Social Security Representative Payee Program Serving Beneficiaries and Minimizing Misuse (2007) / Chapter Skim
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4 Defining and Discovering Misuse
4 Defining and Discovering Misuse
Pages 55-65
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From page 55... ...
The results of this work are covered in the final sections of this chapter. DEFINING MISuSE Formal Definitions For many years, misuse was not formally defined by SSA or by the Social Security Act.
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From page 56... ...
Misuse of benefits occurs when the payee neither uses the benefits for the current and foreseeable needs of the beneficiary, nor conserves benefits for the beneficiary. The document continues to distinguish between misuse and improper use: Improper use of benefits is an unwise expenditure of benefits in a manner that is not in the beneficiary's best interest.
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From page 57... ...
However, breaking rules does not necessarily meet the formal definition of misuse. Because identifying misuse is complex and there are few guidelines from SSA on it, claims representatives are more likely to find a "more suitable" payee rather than to label something an overpayment or to report it as suspected misuse.
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From page 58... ...
Thus, an SSA office may not know the history of a payee who has been replaced or terminated because of suspected or known misuse or violations, which then may continue. CONCLuSION Relying on beneficiaries or third parties to report misuse to Social Security Administration is not a reliable or efficient primary strategy for detecting misuse.
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From page 59... ...
In our site visits and other interviews with SSA staff, we were told that since the inception of the accounting process more than 30 years ago, very little misuse appears to have been detected by this method. CONCLuSION The Social Security Administration does not discover misuse by using the annual accounting form.
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From page 60... ...
However, most payees received an average lump-sum payment of less than $3,000; the highest frequency of payments was in the $1,000 to $1,500 range, which would equal the benefits for a couple of months. (The average monthly federally administered SSI amount was $428.29 in that time period.)
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From page 61... ...
Because the total annual benefit amount is preprinted on the annual accounting form by SSA, it is all too easy for a payee to merely match the claimed spending totals to that amount. Moreover, from the review of the forms, it appears that one can actually put down a different amount of spending and not fail the review as long as the claimed expenses exceed the expected amount.
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From page 62... ...
(Lump-sum amount was $14,119 and the annual report was approved.) CONCLuSION As a practical matter, the Social Security Administra tion does not require representative payees to carefully account for dollars spent in each category on the annual accounting form as long as the total amount spent is approximately the same or greater than the total amount of benefits received.
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From page 63... ...
. RECOMMENDATION .2 The Social Security Administration should develop new procedures and policies that prevent the routine reap pointment of a representative payee who has been documented as a misuser or a continued violator of Social Security Administration poli cies and rules When circumstances dictate retention or reappointment of such payees (e.g., a parent-child situation)
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From page 64... ...
Factual Question: Were you ever unable to get medical attention when None or Some Most or All you thought you needed it? of the Time of the Time Total No 1.6 98.4 100.0 Yes 29.5 70.5 100.0 SOURCE: Data from the national survey of representative payees and beneficiaries conducted for the National Academies Committee on Social Security Representative Payees (2006)
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From page 65... ...
It was apparent from all of these tasks that a new approach is needed to identify the types of representative payees that have the highest risk of misuse of benefits. In the next chapter we present a methodology to discover misuse and thus, ways to reduce the risk of misuse and better protect beneficiaries.
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