Audit Report - A-13-97-92002

Office of Audit

Study of the Social Security Administration’s Operating Procedures Referencing Fraud - A-13-97-92002 - 6/23/97

TABLE OF CONTENTS

INTRODUCTION

FINDINGS

SSA`s POMS Contain Numerous References to Fraud

SSA`s POMS References to Fraud May Not Be Current or Appropriate

RECOMMENDATIONS

APPENDICES

Appendix A - POMS CD-ROM

Appendix E - List of Contributors

INTRODUCTION

PURPOSE

To identify the incidence of references to fraud in the Social Security Administration`s (SSA) procedures and to test those references to determine whether they are current, correct, and consistent.

BACKGROUND

There are four data bases on SSA`s CD-ROM prototype system commonly referred to as the Program Operations Manual System (POMS) CD-ROM. They are POMS, the Modernized Systems Operations Manual (MSOM), the Social Security Handbook, and the Social Security Rulings. The POMS CD-ROM is available to SSA staff on SSA’s intelligent work station/local area network. The discussion that follows focuses only on POMS.

SSA`s POMS

POMS contains SSA`s operating policies and procedures for administering its programs. It is the single repository of all operational information whether issued by central office, a program service center, or a regional office. As such, POMS not only contains operating procedures and policies for administering SSA`s programs, but is also replete with procedures for handling situations where fraud is suspected or detected. POMS procedures are SSA staffs` source of guidance for recognizing, developing, and referring suspected fraud cases to the Office of the Inspector General (OIG).

POMS is divided into 12 parts with each part containing information about a subject area relating to SSA programs, systems, or operations. There are 220 chapters, 1565 subchapters, and 26,822 sections in POMS.

POMS procedures are written by components with expertise in specific program areas. For example, POMS RM 00205.000, Resolving Social Security Number Problems, is written by staff in the Division of Entitlement under the Office of Program Benefits Policy. The Division of Directives Management has responsibility for the preliminary and final review of the procedures. Further, in the Division of Directives Management, the Instructions Policy and Technology Branch has responsibility for the POMS CD-ROM.

OIG`s Mission

OIG`s mission is to improve SSA`s programs and operations and protect them against fraud, waste, and abuse. The effectiveness of OIG in accomplishing this mission is dependent, in part, on the procedural guidance provided to SSA staff on the identification and referral of fraud to OIG. Especially important to OIG`s investigation of fraud are POMS procedures containing sensitive instructions on detecting and reporting violations.

METHODOLOGY

The POMS CD-ROM was utilized to identify all POMS references to fraud. The Search Option on the CD-ROM was used to change the maximum amount of occurrences (100) that the system could identify. A summary list of all "fraud" references was printed and a sample of procedures was selected for review to determine if the procedures were current, correct, and consistent.

Further information on the use of the CD-ROM to identify POMS references to fraud is found in Appendix A.

Back to top

FINDINGS

SSA`s POMS Contain Numerous References to Fraud

SSA`s POMS procedures contain 334 references to fraud. Many of these procedures may not have been reviewed for accuracy or appropriateness since SSA became an independent Agency. A summary list of all references to fraud is found in Appendix B.

SSA`s POMS References to Fraud May Not Be Current or Appropriate

A review of a sample of the references to fraud revealed that the procedures may not be current or appropriate. The following are several examples:

POMS GN 02401.910 B 2 states, "If the case meets 1 above the PC/FCAB/FO will call the servicing OIG office as reflected in GN 04124.010.... POMS GN 04124.010 provides the addresses and telephone phone numbers of OIG`s Office of Investigations field offices. The addresses and phone numbers need to be updated to reflect the current information for these offices." (Note: SSA has revised the above procedure since our review of the POMS references to fraud.)

POMS GN 04020.010 D 3(b) states, "Place a flag ... on the left side of the folder stating that, after all adjudicative actions the case should be routed to the Integrity Branch to determine if it meets criteria for submittal to Health and Human Services, Office of the Inspector General, Office of Investigations Field Office."

POMS GN 04110.010 B 3 has not been revised to reflect that OIG has rescinded guidelines published in January 1994 under the direction of the Department of Health and Human Services which instruct that only certain fraud cases meeting a monetary limit be referred to OIG. POMS procedure directs field office staff to curtail fraud development where the amount of loss to the Government is $2,500 or less.

Back to top

RECOMMENDATIONS

We recommend that:

1. Appropriate Staff From OIG and SSA Should Work Together to Revise Procedures

Our preliminary review indicates the need for a comprehensive review of all references. It is unlikely that this has been done since SSA became an independent Agency and is especially important now in order to ensure appropriate identification, development, and referral procedures and practices. We suggest a joint effort to revise procedures that are no longer considered appropriate. The starting point for this effort should be a review of the POMS sensitive instructions on Violations/Fraud that were co-authored by SSA and OIG.

2. A Similar Approach Could Be Used to Identify References to Fraud in the Social Security Handbook and MSOM

After completing the review of POMS procedures, a similar review should be conducted of all references to fraud in the Social Security Handbook and MSOM. While the incidence of references to fraud in these resources is not as great as in POMS, a review will ensure that all policies and procedures accessible on the CD-ROM are uniform.

AGENCY COMMENTS

The Agency agreed that the procedural references to fraud need to be updated and indicated that the SSA’s Combating Fraud Tactical Plan specifically addresses these procedures. A workgroup comprised of OIG and SSA representatives is to be formed to review current POMS fraud references and modify procedures where appropriate. The Agency commented that after it has completed its review of the POMS procedures, it will determine what action is needed in regard to the MSOM procedures.

Back to top

APPENDICES

APPENDIX A

POMS CD-ROM

The Program Operations Manual System (POMS) CD-ROM is comprised of four data bases that contain the Social Security Administration`s (SSA) policy and procedures. The CD-ROM is designed to allow the user to have on-line access to one, several, or all of the following data bases: POMS, the Modernized Systems Operations Manual (MSOM), the Social Security Handbook, and the Social Security Rulings. The CD-ROM is available on SSA’s intelligent work station/local area network.

POMS contains SSA`s policy and procedures for entitlement and payment of benefits. MSOM provides information on the many systems modernization projects, procedures for users working with the modernized systems, and updates on the various modernized systems projects. The Social Security Handbook summarizes information about the Social Security programs. It is designed to be an easy-to-understand reference tool for the very complex Social Security programs. The Social Security Rulings are a series of judicial decisions relating to Old-Age, Survivors and Disability Insurance, Supplemental Security Income, and Black Lung programs.

A menu screen allows access to these data bases (see Figure 1).

Figure 1

Social Security Administration

CD-ROM Prototype System

The top of the screen allows the user a choice of utilizing a Table of Contents or Index function to locate desired information. The user can utilize the arrow key(s) to highlight Table of Contents, then press enter to obtain the names of the four data bases that are available. The arrow keys can also be used to obtain further information on each data base. For example, highlighting POMS and then pressing the enter key will provide the user with the various parts of POMS. The parts of POMS are;

Part 1 RM Records Maintenance

Part 2 GN General

Part 3 RS Retirement and Survivors

Part 4 DI Disability Insurance

Part 5 SI Supplemental Security Income

Part 6 HI Health Insurance

Part 7 TE Telecommunications

Part 8 SM Systems and Methods

Part 9 NL Correspondence and Notices

Part 10 OS Operational Support

Part 11 DG Digest

Part 12 PM Program Management

Similarly, the Index Search is accessed by highlighting this area of the screen and pressing enter. A sub menu appears that provides the user with a choice of a Comprehensive Index, Forms-Numeric Listing, Forms-Alphabetic Listing, Forms-Other Agencies, or MSOM Page Index. The Comprehensive Index allows the user to view a list of Social Security topics arranged in alphabetical order. To illustrate, the Index would show Aliens, Annual Reports, Appeals ... etc. The forms’ entries allow the user to obtain information on a variety of forms utilized by SSA and other agencies, and the MSOM page index provides page numbers with references to the material contained on those pages.

Below the Table of Contents and Index are spaces to enter POMS sections or an MSOM page number. If the users have knowledge of a particular section of POMS or an MSOM page number needed for their review, they would enter the information in the appropriate space and press enter. The system would locate the reference and indicate at the bottom of the screen to press F1 for the next document or F10 for a summary. A printout of the procedure can be produced by pressing the ALT and P keys.

The Full Text sections allows the user to key a word or phrase (e.g., fraud) and, by pressing the enter key, the system will scan the data base(s) for all references where the phrase "fraud" is used. A message will appear at the bottom of the screen to alert the user to the number of times the phrase was located. The system will display up to the first 100 occurrences unless the user changes the Search option as described below. To view a summary list of all occurrences, the user needs to press the F10 function key.

The bottom portion of the menu screen contains Search Options or Data Base functions. Highlighting the Search Option and pressing enter will produce a screen that is titled Number of Documents. This screen can be utilized to change the maximum number of occurrences from 100 to a larger number. The user may want to use this option if they are searching for all occurrences of a common phrase (e.g., fraud which had 334 references on the summary list). The Data Base selection function is used to indicate the names of the data bases to be searched. Any or all of the data bases listed above can be selected depending on the user’s need.

Back to top

APPENDIX E

LIST OF CONTRIBUTORS

This inspection report was prepared by the Office of Audit in SSA headquarters under the direction of Scott Patterson, Director, Division of Evaluations and Technical Services. Project staff included:

Evan Buckingham, Senior Evaluator