Major Causes of SSI Improper Payments
The table below indicates the major causes of improper payments (overpayments and underpayments) in FY 2019 for the SSI program using OMB’s categories of error:
Improper Payment Root Cause Category Matrix for FY 2019 (dollars in millions) |
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---|---|---|---|
SSI Program | |||
Reason for Improper Payment | Overpayments | Underpayments | |
Monetary Loss Within Agency Control | Monetary Loss Outside Agency Control | ||
Program Design or Structural Issue | $0 | $0 | $0 |
Inability to Authenticate Eligibility: | |||
Inability to Access Data | $0 | $3,996.18 | $453.51 |
Data Needed Does Not Exist | $0 | $221.25 | $170.61 |
Failure to Verify: | |||
Death Data | $0 | $40.16 | $0 |
Financial Data | $90.63 | $0 | $46.52 |
Excluded Party List | $0 | $0 | $0 |
Prisoner Data | $0 | $0 | $0 |
Other Eligibility Data | $37.16 | $0 | $12.51 |
Administrative or Process Error Made by: | |||
Federal Agency | $210.05 | $0 | $41.17 |
State or Local Agency | $0 | $0 | $0 |
Other Party (e.g., participating lender, health care provider, or any other organization administering Federal dollars) | $0 | $0 | $0 |
Medical Necessity | $0 | $0 | $0 |
Insufficient Documentation to Determine | $0 | $0 | $0 |
Other Reason (explain) | $0 | $0 | $0 |
TOTAL | $337.84 | $4,257.59 | $724.32 |
The following tables indicate the major causes of SSI overpayments and underpayments, for FYs 2015-2019, as determined by our payment accuracy reviews:
Major Causes of SSI Overpayments FY 2015 – FY 2019 | |
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Financial Accounts | The applicant or recipient (or his or her parent or spouse) has financial accounts that exceed the allowable resource limits ($2,000 individual/$3,000 couple) that may result in periods of SSI program ineligibility. |
Wages | The recipient (or his or her parent or spouse) has actual wages that exceed the wage amount used to calculate payment. |
In-Kind Support and Maintenance | In-kind support and maintenance is unearned income received in the form of food or shelter. The error results when the recipient’s amount of in-kind support and maintenance is more than the amount used to calculate payment. |
Other Real Property | Undisclosed non-home real property is a growing cause of improper overpayments in the SSI program. SSI ineligibility may result if the recipient is the owner of real property other than his or her principal place of residence. |
Major Causes of SSI Underpayments FY 2015-2019 | |
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In-Kind Support and Maintenance | In-kind support and maintenance is unearned income received in the form of food or shelter. The error results when the recipient’s amount of in-kind support and maintenance is less than the amount used to calculate payment. |
Living Arrangements | We paid the recipient as if he or she was “living in the household of another” when he or she was living in his or her own household for SSI purposes and, therefore, the recipient is due a higher payment amount. |
Wages | The recipient (or his or her parent or spouse) has actual wages that are less than the wage amount used to calculate payment. |