SSA’s [Social Security Administration's] administrative finality rules permit it to continue paying incorrect payment amounts to some beneficiaries and recipients. During our prior and current reviews, we determined that SSA did not correct beneficiary and recipients’ payment amounts when it invoked administrative finality. For example, we identified a beneficiary receiving a full retirement benefit under her own SSN [Social Security Number] and another full benefit under her deceased spouse’s SSN that resulted in an $870 monthly overpayment. The overpayments started in July 1982 and created a total overpayment of approximately $215,000. Since our 2007 recommendation to revise its administrative finality rules, SSA has paid this beneficiary approximately an additional $40,000.10
We identified another beneficiary receiving a full retirement benefit under her own SSN and a full benefit under her deceased spouse’s SSN that resulted in a $373 monthly overpayment. The overpayments started in June 1988 and created a total overpayment of approximately $85,000. SSA had paid this beneficiary approximately $16,000 since our 2007 recommendation. Because of SSA’s administrative finality rules, it will not reopen these cases and these overpayments will continue increasing throughout the beneficiaries’ lifetimes. In addition, SSA does not pursue recovery of these types of improper payments.Is this an accurate statement of Social Security's position? I haven't seen one lately but I've certainly seen cases in past years where Social Security changed current benefits and declared large overpayments in this type of case.
Really, OIG should not be pressuring Social Security on the overpayment part of this kind of case. There's a very good argument that it's against equity and good conscience to try to collect an overpayment when the mistake was clearly made by the agency, could not have reasonably been caught by the beneficiary but should have been caught by the agency's data systems. "Against equity and good conscience" is enough under the statute to get an overpayment waived.
7 comments:
SSA's application of policy on the issue is inconsistent, but official policy is that overpayments cannot be assessed more than 4 years (TII) after the initial determination, absent fraud or some other exception to the administrative finality rules. On SSI, they generally take the position that each month is a new initial determination, so they will reduce an SSI check going forward, but they will limit the assessment of the overpayment going back to 2 years on an SSI claim. Since a Title II administrative determination is generally "fixed" (i.e., new facts don't change the benefit amount) SSA generally applies administrative finality more stringently in Title II cases, so that not only will they not collect the overpayment, but they will continue to pay the erroneous benefits going forward.
All of this is what POMS says. What happens in reality is an entirely different matter. As the OIG implies, SSA does not like applying the restriction, and getting them to follow the administrative finality rules on an overpayment in an actual case is always a war.
I am perplexed. I have only seen administrative finality applied in applying a reduction or termination retroactively (where A/F limits how far back SSA can apply the reduction or termination. Where on earth does it say that A/F means that SSA can NEVER take action to correct an incorrect benefit situation at least prospectively. It seems like, with proper notice, SSA can make any change to benefits. Is there a POMS citation for this?
I assume the issue is that when a notice of award is sent for the second claim for benefits, it counts as an initial determination and if it does not state a change in the other benefit, then it counts as a determination that both benefits are due. If that is not adjusted within 4yrs to account for the "dual-entitlement" status -or termination/suspension of the lower auxiliary benefit- then it stands as a protected initial determination.
HOWEVER, my issue with this is that in GN 04020.010 it is stated we can reopen when fraud or similar fault applies. If the claimant on their claim for the second benefit answers no to the question of any prior application with "no previous application has been filed with the Social Security
Administration by or for me" that should be considered a misleading or incorrect statement that the resulted in the awarding of benefits and not restricted from reopening more than 4yrs afterwards. Whether or not those original applications exist in the above examples is unknown.
CH says... "Really, OIG should not be pressuring Social Security on the overpayment part of this kind of case."
What should OIG do, then? The things you say sometimes make no sense from a practical standpoint.
Charles is a redistributionist -- he wants as much government money as possible to go into the pockets of the disabled and poor (as well as those too lazy or unmotivated to work), with $6000 a case going into his pocket or the pocket of other representatives.
To the poster who wanted a POMS cite, the closest analogy to an erroneous dual entitlement situation I can find is the section on errors in calculation of PIAs, GN 04030.040. https://secure.ssa.gov/apps10/poms.nsf/lnx/0204030050
You will see from the examples that SSA is stuck with paying an incorrectly high benefit indefinitely, assuming the error is first discovered after 4 years from the date of the initial determination (again, policy on SSI checks differ). The poster who pointed out that there may be some other exception to the administrative finality rules (such as fraud) could be correct, but we don't know the facts.
Sorry, that cite above was intended to be to GN 04030.050.
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