Railroad Retirement Board:
Actions Needed to Improve the Effectiveness and Oversight of Continuing Disability Reviews
GAO-18-287: Published: Feb 21, 2018. Publicly Released: Feb 21, 2018.
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What GAO Found
In fiscal years 2014-2016, the Railroad Retirement Board (RRB) completed continuing disability reviews (CDRs) of various types for 427 beneficiaries (see figure below), covering slightly more than 1 percent of the railroad workers who received disability benefits during that period. These reviews included:
Scheduled Medical Reviews –These are scheduled at different intervals depending on the likelihood of medical improvement. RRB data suggest that most beneficiaries are not subject to these CDRs because they are older than 54½, which RRB defines as the age at which they are unlikely to return to work. Of 43 medical CDRs that were scheduled, RRB identified 3 ineligible beneficiaries and 1 overpayment of about $28,000.
High-Risk Reviews – In fiscal year 2015, RRB began conducting medical CDRs on cases it considered to be at high risk for fraud. It completed 166 of these reviews in fiscal years 2015 and 2016, but none identified any ineligible beneficiaries or overpayments.
Earnings Reviews – During fiscal years 2014-2016, 163 earnings CDRs identified 47 ineligible beneficiaries and at least $970,550 in overpayments. However, RRB uses earnings information that can be up to 2 years old, thereby delaying the detection of ineligible beneficiaries and increasing the potential for lost federal dollars. Other federal agencies have access to a national federal database with more recent earnings data. Providing RRB access to these data would enable it to identify overpayments sooner.
Medical + Earnings Reviews – In some cases, RRB conducts both a medical and earnings CDR. RRB's data do not allow GAO to attribute the outcome to either type of CDR.
Continuing Disability Reviews (CDR) Completed by the Railroad Retirement Board for Fiscal Years 2014-2016, by Type and Outcome
RRB oversight has primarily been limited to conducting two internal reviews of high-risk medical CDRs, one of which concluded, consistent with the above results, that these CDRs demonstrated no return on investment. Nevertheless, RRB continues to do them. RRB does not routinely compile and analyze data for all of the CDRs it conducts, which limits its ability to identify potential gaps in oversight and to monitor program performance. For example, RRB lacks data that would help it determine how many medical CDRs it should expect to conduct. RRB officials said compiling data can be challenging because it uses multiple data systems. However, by more efficiently collecting and compiling key CDR data, RRB could enhance its capability to routinely assess program performance.
Why GAO Did This Study
RRB is an independent agency that administers disability benefits for railroad workers. In fiscal year 2016, about 31,000 railroad workers with disabilities received $1.1 billion in disability benefits. RRB is generally required to periodically assess beneficiaries' medical condition or earnings through continuing disability reviews (CDRs) to verify that they remain eligible for disability benefits.
This report examines the extent to which RRB (1) conducts medical and earnings CDRs to ensure the continued eligibility of disability beneficiaries, and (2) oversees the CDR program. GAO analyzed data provided by RRB for CDRs completed in fiscal years 2014-2016, the only years for which complete data were available. GAO also reviewed RRB's policies and procedures, a nongeneralizable random sample of 14 CDR cases that were completed in fiscal year 2016, and relevant federal laws and regulations; and interviewed RRB officials.
What GAO Recommends
Congress should consider giving RRB access to the National Directory of New Hires, a national database of wage and employment information that would enable it to identify potential overpayments sooner. GAO is also making three recommendations to RRB, including that it reconsider the purpose and value of high-risk CDRs, and routinely compile and analyze CDR data to improve oversight. RRB agreed with these recommendations.
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Matter for Congressional Consideration
Comments: N o legislative action identified. As of March 2019 , legislation had not yet been enacted to give the Board access to the National Directory of New Hires, as GAO suggested in February 2018. Access to this national database of wage and employment information would enable the Board to identify potential overpayments sooner. The President's 2019 Budget, however, includes a request to amend the Social Security Act to provide such access for the Board.
Matter: To improve RRB's ability to make accurate disability benefit eligibility determinations, including CDRs, and to decrease the potential for making improper payments, Congress should consider granting RRB access to the Department of Health and Human Services' quarterly earnings information from the National Directory of New Hires database. (Matter for Consideration 1)
Recommendations for Executive Action
Comments: RRB agreed with this recommendation. In August 2018, RRB reported that the agency's Disability Benefits Division (DBD) created a code on the RRB's tracking system, Universal Star (USTAR), for CDR referrals to the Retirement and Survivor Benefits Division (RSBD)--the division that is responsible for processing disability program overpayments identified through CDRs. The new process involves the DBD management entering a code in the USTAR system to alert RSBD staff of the potential overpayment. RRB reported that DBD has referred 93 cases to RSBD, since the code was implemented. Of the cases referred, RSBD has processed approximately 20% of which, 2% (4 cases) were found to have an overpayment. The overpayments totaled $64,274.25 and are in the process of being collected. The RRBs action to address this recommendation will facilitate the processing of disability program overpayments identified through CDRs. To help close this recommendation, however, the RRB will need to develop a standard for the timely processing of program overpayments identified through CDRs.
Recommendation: To enhance RRB's ability to manage and oversee its CDR program, RRB should develop a standard for the timely processing of disability program overpayments identified through CDRs. (Recommendation 1)
Agency Affected: Railroad Retirement Board
Status: Closed - Implemented
Comments: In August 2018, the Board reported that it concurred with GAO's February 2018 recommendation and ceased allocating resources for high-risk CDRs in April 2018. In fiscal year 2015, the Board began conducting medical CDRs on cases it considered to be at high risk for fraud. It completed 166 of these reviews in fiscal years 2015 and 2016, but none identified any ineligible beneficiaries or overpayments. The high-risk CDR outcomes raised questions about the value and benefit of the Board dedicating resources to conduct these additional reviews. The Board is finalizing its amended policies. Ceasing these reviews will make Board resources available for more productive endeavors.
Recommendation: To enhance RRB's ability to manage and oversee its CDR program, RRB should consider whether to reallocate resources used for high-risk CDRs to other CDR efforts that produce more effective outcomes. (Recommendation 2)
Agency Affected: Railroad Retirement Board
Comments: RRB agreed with this recommendation. In August 2018, the agency reported that since October 11, 2017, the Director of Disability has been reporting on a weekly basis the number of pending CDR type action cases to the Director of Programs. In addition, RRB reported that its Policy and Systems unit has been working with the Bureau of Information Systems since October 2017 to revise the screens in its disability tracking systems to track the CDR reason codes for each medical improvement category. According to RRB officials, this project is continuing as staffing permits. The actions RRB are taking to address this recommendation will help the agency to improve its CDR program oversight. To help close this recommendation, however, RRB will need to complete its ongoing actions to track the number of beneficiaries in each medical improvement category, and routinely compile and analyze CDR program data.
Recommendation: To enhance RRB's ability to manage and oversee its CDR program, RRB should routinely compile and analyze CDR program data, such as the number of cases selected for review, the number of beneficiaries in each medical improvement category, outcomes, and the costs and benefits of conducting CDRs, to improve program oversight. (Recommendation 3)
Agency Affected: Railroad Retirement Board