Woods, 51, said she had rented a three-bedroom house she shared with her adult son and grandson until March 2022, when the government terminated her disability payments without notice.

According to letters sent by the Social Security Administration, the agency determined it had been overpaying Woods and demanded she send back nearly $58,000.

Woods couldn’t come up with the money. So, until February 2026, the agency is withholding the $2,048 in disability she would have received each month.

“I still don’t know how it happened,” said Woods, who has requested a waiver and is seeking a hearing. “No one will give me answers. It takes weeks or months to get a caseworker on the phone. They have made my life unbearable.”

Kilolo Kijakazi, acting commissioner of the Social Security Administration, told a congressional subcommittee in October that her agency notifies recipients when they have received overpayments and works to “help those who want to establish repayment plans or who seek waiver of the debt.”

But relief from overpayments goes to only a relatively small number of people. And many others face dire consequences: Some become homeless, are evicted from rental housing, or see their mortgages fall into foreclosure.

The SSA has a painful legacy of excluding Black people from benefits. Today the agency’s own published research shows its overpayments most often hit Black and Hispanic people, the poorest of the poor, those with the least education, and those whose medical conditions are unlikely to improve.

Woods is one of millions who have been targeted in the Social Security Administration’s attempt to claw back billions of dollars it says was wrongly sent to beneficiaries. Years can pass before the agency catches a mistake, and even the little bit extra it might send each month can add up.

In reclaiming it, the government is imposing debts that can reach tens of thousands of dollars against those least able to pay.

(WHIO, Dayton)

‘Wreaking Havoc in People’s Lives’

KFF Health News and Cox Media Group reporters interviewed people who have received overpayment notices and nonprofit attorneys who advocate for them and reviewed SSA publications, policy papers, and congressional testimony.

A 64-year-old Florida man said he could no longer afford rent after his Social Security retirement payments were garnished last year because he allegedly had been overpaid $35,176 in disability benefits. He said he now lives in a tent in the woods. A 24-year-old Pennsylvania woman living with her mother and younger siblings in public housing lost the chance to buy her own home because of an alleged $6,063 overpayment that accrued when she was a child.

“Social Security overpayments are wreaking havoc in people’s lives,” said Jen Burdick, an attorney with Community Legal Services of Philadelphia, which represents clients who have received overpayment notices. “They are asking the poorest among us to account for every dollar they get. Under their rules, some people can save up money for a funeral burial but not enough to get housing.”

Woods has lupus and congestive heart failure and struggles to walk, but she started working part-time after her benefits were rescinded. She said she makes $14 an hour transporting railroad crew members in her 2015 Chevy Equinox between Savannah and Jacksonville, Florida, when she can get assignments and her health allows it.

The SUV costs $386 a month — a large portion of her income — but without it, Woods said, she would not have a job or a place to sleep.

“My life is just survival now,” Woods said. “Sometimes I feel like I am just waiting to die.”

The Social Security Administration has said it is required by law to attempt to recover overpayments. Notices ask beneficiaries to repay the money directly. Authorities can also recoup money by reducing or halting monthly benefits and garnishing wages and federal tax refunds.

Agency officials describe an orderly process in which they explain to beneficiaries the reason for the overpayment and offer the chance to appeal the decision and have the charges waived if they cannot afford it. One way to qualify for a waiver is if “paying us back would mean you could not pay your bills for food, clothing, housing, medical care or other necessary expenses,” according to a letter sent to one recipient.

Those most impacted by Social Security’s decisions, including people with disabilities and widows receiving survivors’ benefits, paint a different picture. They talk about having their benefits terminated without explanation or warning, an appeals process that can drag on for years, and an inability to get answers from the SSA to even basic questions.

Nancy Altman, president of Social Security Works, a group that pushes for the protection and expansion of the program, recalled how stressful it was when a colleague’s mother received an overpayment notice.

“After weeks of nonstop phone calls, he was able to get the matter resolved, but not before it put his mother in the hospital,” Altman said. “One can just imagine how much worse it would be for someone for whom English is not their native language, who lacks a high school education, and who is unassisted by such a knowledgeable and caring advocate.”

Problems surrounding the Social Security Administration are aggravated by congressional actions, including funding shortages that brought agency staffing to a 25-year low by the end of fiscal year 2022. Even so, advocates for people with disabilities say the agency does far less than it could to help people who have been overpaid, often through no fault of their own.

They said challenges faced by beneficiaries underscore how overpayments disproportionately impact Black people and other minority groups even as President Joe Biden and Social Security leaders promise to fix racial inequity in government programs.

Most overpayments are linked to the Supplemental Security Income program, which gives money to people with little or no income who are disabled, blind, or at least 65. The majority of SSI recipients are Black, Hispanic, or Asian people.

“Congress has turned a blind eye to this,” said David Weaver, a former associate commissioner for research, demonstration, and employment support at the SSA. Politicians “just want to save money. It is misplaced priorities. It is completely inexcusable.”

The Social Security Administration did not make its leaders available for an interview. Spokesperson Nicole Tiggemann declined to answer questions about the cases of Woods and other beneficiaries, citing privacy laws.

In a written statement, Tiggemann acknowledged that receiving an overpayment notice can be “unsettling,” but said the agency helps beneficiaries navigate the process and informs them of their rights if they believe they were not at fault or cannot repay the debt.

“Even if they do not want to appeal or request a waiver, the notice says to contact us if the planned withholding would cause hardship,” Tiggemann said. “We have flexible repayment options — including repayment of as low as $10 per month. Each person’s situation is unique, and we handle overpayments on a case-by-case basis.”

Critics say fighting an overpayment notice is not that simple.

Beneficiaries — many challenged by physical, mental, or intellectual disabilities — often are overwhelmed by complex paperwork or unable to find financial documents that may be years old.

The Social Security Administration has the authority to waive overpayments if officials determine recovering them would violate “equity and good conscience,” or the disputed amount falls below certain thresholds. The agency’s guidance also says collecting an overpayment “defeats the purpose” when the “individual needs substantially all of their current income to meet their current ordinary and necessary living expenses.”

Advocates for people with disabilities contend most overpayments arise from delays in processing paperwork and errors by the Social Security Administration or recipients making innocent mistakes. The agency can waive overpayments when the beneficiary is found not at fault.

But in fiscal year 2023, the Social Security Administration collected about $4.9 billion in overpayments with an additional $23 billion yet uncollected, according to an agency report. Just $267 million was waived, the report said.

David Camp, the interim chief executive officer of the National Organization of Social Security Claimants’ Representatives, which advocates for improvements in federal disability programs, said the Social Security Administration is a “broken structure.”

The agency sometimes tries to claw back overpayments from people falsely accused of failing to provide required documents, Camp said.

“Dropping off forms at their field offices is not a guarantee” paperwork will be processed, he said. “Mail is slow, or it doesn’t get opened. We see it so many times you are left with the idea that has to do with the structure.”

(WFXT, Boston)

Left Destitute

Advocacy groups and others said they don’t know how many people become homeless after their benefits are terminated, but they say anecdotal accounts are common.

A study found that more than 800,000 disability applicants from 2007 to 2017 experienced homelessness. Advocates say it only makes sense that overpayments could lead more people to become homeless, since nearly 40% of people receiving disability benefits experience food insecurity and cannot keep up with their rent and utility bills, according to research.

Ronald Harrell sleeps in the woods near Wildwood, Florida, about 50 miles northwest of Orlando. He said he shelters in a tent, cooks his meals on a small grill, and showers at a friend’s house.

Harrell, 64, said he rented a room in a house for $125 a week until last year, when the Social Security Administration cut off his retirement benefits.

A letter the SSA sent him, dated Feb. 6, 2023, says his benefits are being withheld because of overpayment of $35,176 that accrued when Harrell received disability payments. The letter acknowledges he has asked the agency to lower his payments.

“I don’t know how they are doing this to me,” Harrell said. “I did everything by the law.”

Harrell said he once worked as an HVAC technician, but nerve damage left him unable to work sometime around 2002.

He said he collected disability benefits until about 2009, when rehabilitation allowed him to return to the workforce, and he said he reported the information to the federal government. Harrell said he applied for early Social Security retirement benefits last year when his health again declined.

“I started working when I was 16,” Harrell said. “I never thought my life would be like this.”

Kijakazi, the acting Social Security commissioner, and others have said overpayments stem at least partly from low staffing and budget cuts.

From 2010 to 2023, the agency’s customer service budget dropped by 17%, after inflation, according to a report by the Center on Budget and Policy Priorities, a think tank that conducts research on government programs.

At the same time, the report says, the number of Social Security beneficiaries grew by nearly 12 million people, or 22%.

Jonathan Stein, a former attorney with Community Legal Services of Philadelphia who has participated in workgroups and meetings with federal officials about access to Social Security payments for vulnerable populations, said budget cuts cannot fully account for the agency’s penchant for denying applications and terminating benefits.

Officials suspended Supplemental Security Income benefits for about 136,540 people in 2019 for “failure to furnish report,” which means they did not meet deadlines or paperwork requirements, Stein said, despite knowing many of those people were unable to contact the agency because they are homeless or have been evicted and lost access to phones and computers.

That’s more than double the number in 2010, he said.

“They have an implicit bias for denying benefits,” Stein said. “It is a very skewed view of integrity. It reinforces a culture of suspicion and prosecution of applicants.”

The 24-year-old Pennsylvania woman who received Supplemental Security Income as a child because of a learning disability described her ordeal on the condition that her name not be published. A letter from the Social Security Administration says she received an overpayment notice for more than $6,000.

“It was frustrating,” the woman said. “You are dealing with nasty people on the phone. I couldn’t get any answers.”

In November 2022, she contacted a nonprofit law firm, which helped her file an appeal. One year later, she received another letter from Social Security saying the overpayment had been waived because it was not her fault. The letter also said officials would not seek repayment because she could not afford basic needs such as food and housing without the monthly benefits.

The woman had already paid a price.

She lived in public housing and the Philadelphia Housing Authority had offered her a chance to fulfill a long-held goal of owning a house. But when the overpayment appeared on her credit report, she said, she could not obtain a mortgage.

“I was excited about getting my own home,” she said. “That’s what everybody wants. Losing it is not a good feeling.”

David Hilzenrath of KFF Health News, Jodie Fleischer of Cox Media Group, and Ben Becker of ActionNewsJax in Jacksonville, Florida, contributed to this report.

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

“I want to apologize for any confusion or misunderstanding during the October hearing,” acting Commissioner Kilolo Kijakazi wrote in a letter dated Dec. 11.

Kijakazi sent the letter days after KFF Health News and Cox Media Group reported that the agency has been demanding money back from more than 2 million people a year — more than twice as many as Kijakazi disclosed to a House panel at an Oct. 18 hearing.

The report was based on a Social Security document the news organizations obtained through a records request under the Freedom of Information Act.

“In my effort to be responsive to Committee questions on overpayment numbers, I provided a preliminary, unvetted and partial answer,” Kijakazi said in her apology letter.

“My goal — and SSA’s goal — is always to provide Congress with the most complete, accurate, and responsive information possible,” Kijakazi said. “We did not do that in this case and will use this experience to improve our communications with Congress going forward.”

In an interview before she sent the apology, Rep. Greg Steube (R-Fla.) said Kijakazi “wasn’t being completely upfront” at the hearing, and he wondered whether the agency had “intentionally deflated the numbers.”

Meanwhile, in a Dec. 12 interview, the chairman of the Senate Finance Committee, Ron Wyden (D-Ore.), said the agency had damaged its credibility by “not telling the truth.”

(WFXT-TV, Boston)

(WSB-TV, Atlanta)

The hearing of the House Ways and Means Committee’s Subcommittee on Social Security focused on the agency’s record of sending out billions of dollars of benefit payments that it later concludes it never should have paid — and then, sometimes years later, demanding the recipients pay the money back.

The unexpected bills, which can total tens of thousands of dollars or more, can be devastating for the recipients. Many are disabled and struggling to get by on minimal incomes.

Until the hearing, the agency had not disclosed the number of people affected, making it harder for policymakers to assess the seriousness of the problem and what to do about it.

At the hearing, Rep. Mike Carey (R-Ohio) asked how many people a year are receiving overpayment notices.

Reading from a piece of paper, Kijakazi gave two precise numbers: 1,028,389 for the 2022 fiscal year and 986,912 for the 2023 fiscal year.

Under further questioning, she repeated the numbers.

She also said they were “under Social Security” and “for Social Security.”

After the hearing, KFF Health News and Cox Media Group sent the Social Security press office several emails over a period of weeks asking for clarification: Did the numbers Kijakazi gave at the hearing represent all programs administered by the Social Security Administration, or just a subset?

SSA spokesperson Nicole Tiggemann did not give a direct answer.

The news organizations filed the FOIA request for a copy of the document from which Kijakazi read the numbers at the hearing.

The document showed that Kijakazi did not tell House members the whole story.

She read numbers that included two benefit programs, but she repeatedly omitted numbers for a third program her agency administers under the Social Security Act. The numbers she omitted were bigger than the numbers she disclosed, and, on the piece of paper, they appeared directly below the numbers she disclosed.

She left out more than a million people a year.

More than seven weeks passed before she sent Congress the apology.

(WSOC-TV, Charlotte)

(WFTV-TV, Orlando)

“We should have followed up with additional context following the hearing,” she said in her letter. “I take seriously the commitment that all Federal officials make to provide the Congress with accurate information and I very much regret not contacting you with more information right away.”

KFF Health News and Cox Media Group obtained a copy of the letter addressed to Rep. Drew Ferguson (R-Ga.), chair of the Ways and Means’ Subcommittee on Social Security, and a copy sent to a Democratic member of the committee.

Asked which members of Congress were sent the letter, Tiggemann said in an email, “The correspondence was between Acting Commissioner Kijakazi and members of the committee.”

Tiggemann did not respond to a request for an interview with Kijakazi.

In her letter, Kijakazi essentially disavowed the numbers she gave the committee. She said the agency is trying to make sure it has “the right data to make meaningful improvements.”

“We are committed to sharing this data with the Committee and the public,” she wrote, “as soon as it is fully vetted.”

Addressing overpayment problems — and communicating with Congress about them — will soon be someone else’s responsibility.

The evening of Dec. 18, the Senate voted 50 to 11 to confirm former Maryland Gov. Martin O’Malley (D) as commissioner of Social Security.

At his confirmation hearing in November, O’Malley said he would “absolutely prioritize” reducing overpayments and overhauling the appeals process for people asked to repay money.

“It’s been heartbreaking reading some of these stories” of people who face government collection efforts “through no fault of their own” and “without regard” for their circumstances, O’Malley said.

“We have to do a better job of recognizing the justice at stake in each of these individual cases,” O’Malley, a former presidential candidate, said at the hearing.

O’Malley said he would emphasize improving customer service, measuring results, and disclosing data.

Instead of hoarding information, he said, “you need to share information openly and transparently.”

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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In more than 4,200 comments, readers shared their struggles in caring for spouses, older parents, and grandparents. They expressed anxieties about getting older themselves and needing help to stay at home or in institutions like nursing homes or assisted living facilities.

Many suggested changes to U.S. policy, like expanding the government’s payments for care and allowing more immigrants to stay in the country to help meet the demand for workers. Some even said they would rather end their lives than become a financial burden to their children.

Many readers blamed the predominantly for-profit nature of American medicine and the long-term care industry for depleting the financial resources of older people, leaving the federal-state Medicaid programs to take care of them once they were destitute.

“It is incorrect to say the money isn’t there to pay for elder care,” Jim Castrone, 72, a retired financial controller in Placitas, New Mexico, commented. “It’s there, in the form of profits that accrue to the owners of these facilities.”

“It is a system of wealth transference from the middle class and the poor to the owners of for-profit medical care, including hospitals and the long-term care facilities outlined in this article, underwritten by the government,” he added.

Other readers pointed to insurance policies that, despite limitations, had helped them pay for services. And some relayed their concerns that Americans were not saving enough and were unprepared to take care of themselves as they aged.

What Other Nations Provide

Other countries’ treatment of their older citizens was repeatedly mentioned. Readers contrasted the care they observed older people receiving in foreign countries with the treatment in the United States, which spends less on long-term care as a portion of its gross domestic product than do most wealthy nations.

Marsha Moyer, 75, a retired teaching assistant in Memphis, Tennessee, said she spent 12 years as a caregiver for her parents in San Diego County and an additional six for her husband. While they had advantages many don’t, Moyer said, “it was a long, lonely job, a sad job, an uphill climb.”

By contrast, her sister-in-law’s mother lived to 103 in a “fully funded, lovely elder care home” in Denmark during her last five years. “My sister-in-law didn’t have to choose between her own life, her career, and helping her healthy but very old mother,” Moyer said. “She could have both. I had to choose.”

Birgit Rosenberg, 58, a software developer in Southampton, Pennsylvania, said her mother had end-stage dementia and had been in a nursing home in Germany for more than two years. “The cost for her absolutely excellent care in a cheerful, clean facility is her pittance of Social Security, about $180 a month,” she said. “A friend recently had to put her mother into a nursing home here in the U.S. Twice, when visiting, she has found her mother on the floor in her room, where she had been for who knows how long.”

Brad and Carol Burns moved from Fort Worth, Texas, in 2019 to Chapala, Jalisco, in Mexico, dumping their $650-a-month long-term care policy because care is so much more affordable south of the border. Brad, 63, a retired pharmaceutical researcher, said his mother lived just a few miles away in a memory care facility that costs $2,050 a month, which she can afford with her Social Security payments and an annuity. She is receiving “amazing” care, he said.

“As a reminder, most people in Mexico cannot afford the care we find affordable and that makes me sad,” he said. “But their care for us is amazing, all health care, here, actually. At her home, they address her as Mom or Barbarita, little Barbara.”

Insurance Policies Debated

Many, many readers said they could relate to problems with long-term care insurance policies, and their soaring costs. Some who hold such policies said they provided comfort for a possible worst-case scenario while others castigated insurers for making it difficult to access benefits.

“They really make you work for the money, and you’d better have someone available who can call them and work on the endless and ever-changing paperwork,” said Janet Blanding, 62, a technical writer in Fancy Gap, Virginia.

Derek Sippel, 47, a registered nurse in Naples, Florida, cited the $11,000 monthly cost of his mother’s nursing home care for dementia as the reason he bought a policy. He pays about $195 a month with a lifetime benefit of $350,000. “I may never need to use the benefit[s], but it makes me feel better knowing that I have it if I need it,” he said in his comment. He said he could not make that kind of money by investing on his own.

“It’s the risk you take with any kind of insurance,” he said. “I don’t want to be a burden on anyone.”

Pleas for More Immigrant Workers

One solution that readers proposed was to increase the number of immigrants allowed into the country to help address the chronic shortage of long-term care workers. Larry Cretan, 73, a retired bank executive in Woodside, California, said that over time, his parents had six caretakers who were immigrants. “There is no magic bullet,” he said, “but one obvious step — hello, people — we need more immigrants! Who do you think does most of this work?”

Victoria Raab, 67, a retired copy editor in New York, said that many older Americans must use paid help because their grown children live far away. Her parents and some of their peers rely on immigrants from the Philippines and Eritrea, she said, “working loosely within the margins of labor regulations.”

“These exemplary populations should be able to fill caretaker roles transparently in exchange for citizenship because they are an obvious and invaluable asset to a difficult profession that lacks American workers of their skill and positive cultural attitudes toward the elderly,” Raab said.

Federal Fixes Sought

Other readers called for the federal government to create a comprehensive, national long-term care system, as some other countries have. In the United States, federal and state programs that finance long-term care are mainly available only to the very poor. For middle-class families, sustained subsidies for home care, for example, are fairly nonexistent.

“I am a geriatric nurse practitioner in New York and have seen this story time and time again,” Sarah Romanelli, 31, said. “My patients are shocked when we review the options and its costs. Medicaid can’t be the only option to pay for long-term care. Congress needs to act to establish a better system for middle-class Americans to finance long-term care.”

John Reeder, 76, a retired federal economist in Arlington, Virginia, called for a federal single-payer system “from birth to senior care in which we all pay and profit-making [is] removed.”

Other readers, however, argued that people needed to take more responsibility by preparing for the expense of old age.

Mark Dennen, 69, in West Harwich, Massachusetts, said people should save more rather than expect taxpayers to bail them out. “For too many, the answer is, ‘How can we hide assets and make the government pay?’ That is just another way of saying, ‘How can I make somebody else pay my bills?’” he said, adding, “We don’t need the latest phone/car/clothes, but we will need long-term care. Choices.”

Questioning the Value of Life-Prolonging Procedures

A number of readers condemned the country’s medical culture for pushing expensive surgeries and other procedures that do little to improve the quality of people’s few remaining years.

Thomas Thuene, 60, a consultant in Boston’s Roslindale neighborhood, described how a friend’s mother who had heart failure was repeatedly sent from the elder care facility where she lived to the hospital and back, via ambulance. “There was no arguing with the care facility,” he said. “However, the moment all her money was gone, the facility gently nudged my friend to think of end-of-life care for his mother. It seems the financial ruin is baked into the system.”

Joan Chambers, 69, an architectural draftsperson in Southold, New York, said that during a hospitalization on a cardiac unit she observed many fellow patients “bedridden with empty eyes,” awaiting implants of stents and pacemakers.

“I realized then and there that we are not patients, we are commodities,” she said. “Most of us will die from heart failure. It will take courage for a family member to refuse a ‘simple’ procedure that will keep a loved one’s heart beating for a few more years, but we have to stop this cruelty.

“We have to remember that even though we are grateful to our health care professionals, they are not our friends. They are our employees and we can say no.”

One physician, James Sullivan, 64, in Cataumet, a neighborhood of Bourne, Massachusetts, said he planned to refuse hospitalization and other extraordinary measures if he suffered from dementia. “We spend billions of dollars, and a lot of heartache, treating demented people for pneumonia, urinary tract infections, cancers, things that are going to kill them sooner or later, for no meaningful benefit,” Sullivan said. “I would not want my son to spend his good years, and money, helping to maintain me alive if I don’t even know what’s going on,” he said.

Considering ‘Assisted Dying’

Others went further, declaring they would rather arrange for their own deaths than suffer in greatly diminished capacity. “My long-term care plan is simple,” said Karen Clodfelter, 65, a library assistant in St. Louis. “When the money runs out, I will take myself out of the picture.” Clodfelter said she helped care for her mother until her death at 101. “I’ve seen extreme old age,” she said, “and I’m not interested in going there.”

Some suggested that medically assisted death should be a more widely available option in a country that takes such poor care of its elderly. Meridee Wendell, 76, of Sunnyvale, California, said: “If we can’t manage to provide assisted living to our fellow Americans, could we at least offer assisted dying? At least some of us would see it as a desirable solution.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The Social Security Administration assured lawmakers in the past that it had been addressed, but “what you all found in your reporting is that the problem hadn’t been fixed,” Finance Committee Chair Ron Wyden (D-Ore.) said in an interview.

Wyden was referring to an ongoing investigation by KFF Health News and Cox Media Group television stations reporting how the agency has been issuing billions of dollars in overpayments — benefits it claims people never should have received — and then, sometimes years later, demanding they pay the money back.

“Millions of these individuals are walking an economic tightrope, balancing their food bill against the fuel bill, the fuel bill against the rent bill,” Wyden said. “And they have one of these overpayments and it just hits them like a wrecking ball.”

Meanwhile, congressional legislation that would raise asset limits for millions of Social Security recipients for the first time in decades has been gaining support.

The amounts the agency alleges people owe the government often total tens of thousands of dollars. The recipients include many of the nation’s most vulnerable — people who are disabled and have minimal savings and incomes. Often the overpayments result from errors or lapses on the part of the Social Security Administration.

The agency has been sending overpayment notices to more than 2 million people a year, according to a government document KFF Health News and CMG obtained through a request under the Freedom of Information Act. The notices typically ask recipients to repay the government within 30 days. They also explain how to appeal or request that the government waive the debt.

The Finance Committee oversees Social Security. Wyden spoke with KFF Health News and CMG on Dec. 12 in his first interview with the news organizations since they began reporting on Social Security overpayments and clawbacks months ago. He was elaborating on a statement the committee posted last week.

“As the point person for getting this fixed, I’m committing to getting this turned around,” Wyden said.

“Your reporting has just been invaluable in terms of kind of opening up a lot of visibility and awareness to something that needs to be fixed.”

Wyden is co-sponsor of a Senate bill that would address one of the root causes of overpayments.

(WSB-TV, Atlanta)

In the Supplemental Security Income program, which provides monthly checks to people who have little or no income or assets and are over 65 or disabled, asset limits for beneficiaries haven’t been adjusted since the 1980s. Those limits stand at $2,000 for individuals and $3,000 for couples.

The bill, spearheaded by Sens. Sherrod Brown (D-Ohio) and Bill Cassidy (R-La.), would raise the asset limits to $10,000 and $20,000, respectively, and adjust them for inflation in the future.

The bill has seven other co-sponsors in the Senate, including recent additions Lisa Murkowski (R-Alaska) and Sen. Patty Murray (D-Wash.), chair of the Appropriations Committee.

Chief executives of several major Wall Street firms, including Bank of America, Citigroup, Goldman Sachs, and Morgan Stanley, expressed support for the bill at a recent hearing, CNBC reported.

At a September news conference on Capitol Hill, a representative of JPMorgan Chase, which also backs the proposal, said the asset limits often prevent employees from participating in a 401(k) retirement plan to which the firm makes matching contributions.

A parallel bill in the House of Representatives has 10 lawmakers behind it.

“With growing bipartisan support in Congress and among the business and faith communities, we have a good chance to finally get this done,” Brown said in a statement for this article.

Legislation to raise the asset limits could be included in a government funding bill early next year, Brown spokesperson Kevin Donohoe said.

Wyden said he hopes the legislation becomes a campaign issue in the election year and that candidates are asked whether they support it.

The monthly meetings with the Social Security Administration will begin when a new commissioner is in place, Wyden said. President Joe Biden’s nominee to head the agency, former Maryland Gov. Martin O’Malley (D), cleared the Finance Committee and is awaiting a confirmation vote by the full Senate.

In a recent hearing, O’Malley said accounts of people facing clawbacks were “heartbreaking” and promised to make the issue a priority.

Wyden said he expects the oversight meetings will include the top Republican on the Finance Committee, Sen. Mike Crapo of Idaho.

A spokesperson for Crapo, Mandi Critchfield, said he “is committed to addressing the overpayments issue, and looks forward to working with Senator Wyden to conduct proper oversight.”

One of the goals for those meetings, Wyden said, is to find out whether the agency can do more about overpayments using the legal powers it already has, including the authority to waive debts.

Wyden said he has discussed Social Security overpayments and clawbacks with officials at the White House.

In the interview, Wyden also addressed a recent report by KFF Health News and CMG that, according to the results of a public records request, the SSA has been sending overpayment notices to over a million more people a year than the agency’s acting commissioner, Kilolo Kijakazi, disclosed at an October House hearing.

“When you have Social Security officials not telling the truth — and that’s how I would characterize that report on the number of people for whom there was actually a problem — it really damages this incredibly important program’s credibility,” Wyden said.

The news organizations obtained a copy of a piece of paper from which Kijakazi read aloud some numbers but not others at the October hearing.

SSA spokesperson Nicole Tiggemann said last week the agency could not confirm the accuracy of the counts — those Kijakazi presented at the hearing and those she left out.

Meanwhile, senior Democrats on the House Ways and Means Committee issued a statement this week calling for action on overpayments and clawbacks.

“Recent news reports have highlighted that the harm and unfairness Social Security beneficiaries experience after unknowingly being overpaid is more widespread than previously thought,” Reps. John B. Larson of Connecticut and Danny K. Davis of Illinois said.

Larson is the ranking Democrat on the Ways and Means Subcommittee on Social Security, and Davis is the ranking Democrat on the Subcommittee on Work and Welfare.

“The need for action is clear,” they said. “There must be a fundamental overhaul of Social Security’s overpayment process – one that puts seniors and Americans with severe disabilities first.”

While the government is at fault for some overpayments, others result from beneficiaries failing to comply with requirements, intentionally or otherwise. That can include failing to keep the SSA updated about items such as earnings, assets, and in-kind support — for example, whether family members are giving the beneficiary food or a place to stay.

Systemic problems also contribute.

The SSA has relied on manual systems, and those are subject to human error.

Rules are complex and difficult for SSA staff and beneficiaries alike to follow.

People who receive federal disability benefits yet try to work can easily run afoul of restrictions not only on how much they are allowed to save but also on how much they are allowed to earn. For individuals who aren’t blind, the monthly limit is $1,470.

The SSA relies heavily on beneficiaries to report changes in income, assets, and the like. For instance, the agency has been slow to implement systems that would automatically tap payroll data from outside sources.

Beneficiaries and advocates for Social Security recipients say the agency frequently loses information they submit. Getting through to humans at the agency can be extremely difficult, they say. Wait times are long, and calls get dropped.

O’Malley, the nominee for commissioner, recently told the Senate Finance Committee that the agency has a “customer service crisis.”

“The current wait times, backlogs, and delays are simply unacceptable,” O’Malley wrote.

The agency has cited staffing and funding. In the 2023 fiscal year, “we began to rebuild our workforce after ending FY 2022 with the lowest staffing level in 25 years,” the acting commissioner said in an October statement to a congressional subcommittee.

The agency closed field offices during the pandemic. That made it more difficult for beneficiaries to communicate with the SSA, and it caused problems to pile up.

The agency checks benefits retrospectively, which leaves it playing catch-up, researchers at the Urban Institute have said.

Regardless of who was originally at fault, by the time the SSA issues an overpayment notice, years can pass and the alleged overpayment total can balloon.

Under federal law, the agency must try to recover overpaid amounts, Kijakazi said in her October statement, and there is no statute of limitations. To collect debts, the SSA can reach back decades and across generations.

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Peterson, who has quadriplegia, is an enthusiastic participant in an unusual test of autonomous vehicles in this corner of northern Minnesota. She helped attract government funding to bring five self-driving vans to Grand Rapids, a city of 11,000 people in a region of pine and birch forests along the Mississippi River.

The project’s self-driving vans always have a human operator in the driver’s seat, poised to take over in complicated situations. But the computers are in control about 90% of the time, and they’ve given 5,000 rides since 2022 without any accidents, organizers say.

“It’s been fun. I’m really sold on it,” said Peterson, who used to rely on her power wheelchair to travel around town, even in winter.

Autonomous vehicles, which can drive themselves at least part of the time, are making news in urban areas, such as San Francisco, where extensive tests of the technology are underway.

Rural experiments have been set up in a few other states, including Iowa and Ohio. Peterson hopes the pilot projects help bring a day when fully autonomous cars and vans assist the estimated 25 million Americans whose travel is limited by disabilities.

Fully independent vehicles remain far from everyday options, as tech companies and automakers struggle to perfect the technology. Recently, for example, General Motors recalled all its self-driving cars after one struck and dragged a pedestrian who had been hit by another vehicle.

But Waymo, a corporate relative of Google, is forging ahead with fully autonomous taxi rides in multiple cities.

Peterson is among those who believe autonomous vehicles someday will become safer than human-driven models.

“Look at how many times the lightbulb failed before it worked,” she said.

Unlike many smaller towns, Grand Rapids has public buses and a taxi service. But Peterson said those options don’t always work well, especially for people with disabilities. The autonomous vehicle program, known as goMARTI, which stands for Minnesota’s Autonomous Rural Transit Initiative, offers a flexible alternative, she said. She hopes it eventually will ease a national shortage of drivers, which tends to be especially acute in rural regions.

The project is funded through the spring of 2027 with more than $13 million from federal, state, and local sources, much of it coming from the 2021 federal infrastructure bill.

The project’s distinctive Toyota minivans are outfitted by a Michigan company, May Mobility, which is backed by the Japanese auto giant and other investors. Slogans painted on the side invite the public to “Experience Self Driving in Minnesota’s Nature.” The vans bristle with technology, including cameras, radar, GPS, and laser sensors. Their computer systems constantly monitor surroundings and learn from situations they encounter, said Jon Dege, who helps manage the project for May Mobility.

Users arrange free rides via a smartphone app or the 211 social service telephone line.

On a recent chilly afternoon, a goMARTI van pulled up near Peterson’s house. She soon emerged, bundled in a bright purple parka honoring her beloved Minnesota Vikings football team. She rolled her electric wheelchair to the van, up a ramp, and into the back. Van operator Mark Haase helped strap the wheelchair in, then climbed into the driver’s seat for a demonstration.

As the van pulled onto the street, the steering wheel seemed to shudder, reflecting tiny adjustments the computer made. Haase kept his foot poised near the brake pedal and his hands cupped around the steering wheel, ready to take over if a complication came up. After moments when he needed to take control of the vehicle, he pressed a button telling the computer system to resume command. “It was weird at first, but it didn’t take long to get used to it and trust the system,” Haase said.

The Minnesota Department of Transportation helped direct federal money toward the Grand Rapids project, which followed a similar effort in the southern Minnesota city of Rochester. Tara Olds, the department’s director of connected and automated vehicles, said her agency sought smaller communities that wanted to give autonomous vehicles a shot.

Neither kind of driver will ever be perfect, Olds said. “You know, humans make mistakes, and computers make mistakes,” she said. But the public would understandably react differently if a fatal crash were caused by an autonomous vehicle instead of a human, she said.

Frank Douma, a research scholar at the University of Minnesota’s Center for Transportation Studies, has analyzed the Grand Rapids project and other autonomous vehicle programs. He said running such projects in smaller towns isn’t necessarily harder than doing so in urban areas. “It’s just different.”

For the foreseeable future, such services probably will need to run on predetermined routes, with regular stops, he said. It would be more complicated to have autonomous vehicles travel on demand to unfamiliar addresses out in the countryside.

Developers will need to overcome significant challenges before autonomous vehicles can become a regular part of rural life, he said. “But it’s no longer something that can be dismissed as impossible.”

A 2022 report from the National Disability Institute predicted that autonomous vehicles could help many people with disabilities get out of their homes and obtain jobs.

Tom Foley, the group’s executive director, said a lack of transportation often causes isolation, which can lead to mental health problems. “There’s an epidemic of loneliness, particularly for older people and particularly for people with disabilities,” he said.

Foley, who is blind, has tried fully autonomous vehicles in San Francisco. He believes someday they will become a safe and practical alternative to human drivers, including in rural areas. “They don’t text. They don’t drink. They don’t get distracted,” he said.

For now, most riders who use wheelchairs need attendants to secure them inside a van before it starts moving. But researchers are looking into ways to automate that task so people who use wheelchairs can take advantage of fully autonomous vehicles.

The Grand Rapids project covers 35 miles of road, with 71 stops. The routes initially avoided parking lots, where human drivers often make unexpected decisions, Dege said. But organizers recognized the street-side stops could be challenging for many people, especially if they’re among the 10% of goMARTI riders who use wheelchairs. The autonomous vans now drive into some parking lots to pick riders up at the door.

During the recent demonstration ride with Peterson and Haase, the van turned into a clinic parking lot. A lady in an orange car cut across the lot, heading for the front of the van. The computer driving the van hit the brakes. A split second later, Haase did the same. The orange car’s driver smiled and gave a friendly Midwestern wave as she drove past.

The autonomous vans have gone out in nearly all kinds of weather, which can be a challenge in northern Minnesota. Grand Rapids received more than 7 feet of snow last winter.

“There were only three or four times when it was so snowy we had to pull it in,” Dege said. The autonomous driving systems can handle snowflakes in the air and ice on the pavement, he said. They tend to get confused by snow piles, however. The human operators step in to assist in those situations while the computers learn how to master them.

The robot drivers can get stymied as well by roundabouts, also known as traffic circles. The setups are touted as safer than four-way stops, but they can befuddle human drivers too.

Haase took control each time the van approached a roundabout. He also took the wheel as the van came up on a man riding a bicycle along the right side of the road. “Better safe than sorry,” Haase said. Once the van was a few yards past the bicycle, he pressed a button that told the robot to resume control.

Peterson takes the vans to stores, restaurants, community meetings, hockey games — “and church, of course, every Sunday and Wednesday,” she said.

She said the project has brought Grand Rapids residents together to imagine a more inclusive future. “It’s not just a fancy car,” she said.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But then something caught her attention: When she went to her doctor last month, she learned that the doctor and the hospital where she works will not accept her insurance next year.

Faced with either finding a new doctor or finding a new plan, Du Bois said the decision was easy. “I’m sticking with her because she knows everything about me,” she said of her doctor, whom she’s been seeing for more than a decade.

Du Bois isn’t the only one tuning out when commercials about the open enrollment deadline flood the airwaves each year — even though there could be good reasons to shop around. But sifting through the offerings has become such an ordeal that few people want to repeat it. Avoidance is so rampant that only 10% of beneficiaries switched Medicare Advantage plans in 2019.

Once open enrollment ends, there are limited options for a do-over. People in Medicare Advantage plans can go to another Advantage plan or back to the original, government-run Medicare from January through March. And the Centers for Medicare & Medicaid Services has expanded the criteria for granting a “special enrollment period” to make changes in drug or Advantage plans anytime.

But most seniors will generally allow their existing policy to renew automatically, like it or not.

Keeping her doctor was not Du Bois’ only reason for switching plans, though. With help from Senior PharmAssist, a Durham nonprofit that advises seniors about Medicare, she found a Humana Medicare Advantage plan that would not only be accepted by her providers but also cover her medications — saving her more than $14,000 a year, said Gina Upchurch, the group’s executive director.

Senior PharmAssist is one of the federally funded State Health Insurance Assistance Programs, known as SHIPs, available across the country to provide unbiased assistance during the open enrollment season and year-round to help beneficiaries appeal coverage denials and iron out other problems.

“Many people are simply overwhelmed by the calls, ads, the sheer number of choices, and this ‘choice overload’ contributes to decision-making paralysis,” said Upchurch. Seniors in Durham have as many as 74 Advantage plans and 20 drug-only plans to choose from, she said.

Upchurch said the big insurance companies like the way the system works now, with few customers inclined to explore other plans. “They call it ‘stickiness,’” she said. “If we had fewer and clear choices — an apple, orange, grape, or banana — most people would review options.”

In Washington state, one woman switched from a plan she had had for more than a decade to one that will cover all her drugs and next year will save an estimated $7,240, according to Tim Smolen, director of the state’s SHIP, Statewide Health Insurance Benefits Advisors.

In Northern California, another woman changed drug plans for the first time since 2012, and her current premium of $86 will plummet to 40 cents a month next year, an annual savings of about $1,000, said Pam Smith, a local director for California’s SHIP, called the Health Insurance Counseling & Advocacy Program.

And in Ohio, a woman sought help after learning that her monthly copayment for the blood thinner Eliquis would rise from $102 to $2,173 next year. A counselor with Ohio’s SHIP found another plan that will cover all her medications for the year and cost her just $1,760. If she stuck with her current plan, she would be paying an additional $24,852 for all her drugs next year, said Chris Reeg, who directs that state’s program.

In some cases, CMS tries to persuade beneficiaries to switch. Since 2012, it has sent letters every year to thousands of beneficiaries in poorly performing Advantage and drug plans, encouraging them to consider other options. These are plans that have received less than three out of five stars for three years from CMS.

“You may want to compare your plan to other plans available in your area and decide if it’s still right for you,” the letter says.

CMS allows low-scoring plans to continue to operate. In an unusual move, officials recently found that one plan had such a terrible track record that they will terminate its contract with government health programs next December.

CMS also contacts people about changing plans during open enrollment if they get a subsidy — called “extra help” — that pays for their drug plan’s monthly premium and some out-of-pocket expenses. Because some premiums will be more expensive next year, CMS is warning beneficiaries that they could be in for a surprise: a monthly bill to cover cost increases the subsidy doesn’t cover.

But many beneficiaries receive no such nudge from the government to find out if there is a better, less expensive plan that meets their needs and includes their health care providers or drugs.

That leaves many people with Medicare drug or Advantage plans on their own to decipher any changes to their plans while there is still time to enroll in another. Insurers are required to alert members with an “annual notice of change,” a booklet often more than two dozen pages long. Unless they plow through it, they may discover in January that their premiums have increased, the provider network has changed, or some drugs are no longer covered. If a drug plan isn’t offered the next year and the beneficiary doesn’t pick a new one, the insurer will select a plan of its choosing, without considering costs or needed drug coverage.

“Every year, our call volume skyrockets in January when folks get invoices for that new premium,” said Reeg, the Ohio program director. At that point, Medicare Advantage members have until March 30 to switch to another plan or enroll in government-run Medicare. There’s no similar grace period for people with stand-alone drug plans. “They are locked into that plan for the calendar year.”

One cost-saving option is the government’s Medicare Savings Program, which helps low-income beneficiaries pay their monthly premium for Medicare Part B, which covers doctor visits and other outpatient services. The Biden administration’s changes in eligibility for subsidies announced in September will extend financial assistance to an estimated 860,000 people — if they apply. In the past, only about half of those eligible applied.

Fixing a mistake after the open enrollment period ends Dec. 7 is easy for some people. Individuals who receive “extra help” to pay for drug plan premiums and those who have a subsidy to pay for Medicare’s Part B can change drug plans every three months.

At any time, beneficiaries can switch to a Medicare Advantage plan that earns the top five-star rating from CMS, if one is available. “We’ve been able to use those five-star plans as a safety net,” said Reeg, the Ohio SHIP director.

Other beneficiaries may be able to get a “special enrollment period” to switch plans after the open enrollment ends if they meet certain conditions. Local SHIP offices can help people make any of these changes when possible.

Reeg spends a lot of time trying to ensure that unwelcome surprises — like a drug that isn’t covered — don’t happen in the first place. “What we want to do is proactively educate Medicare patients so they know that they can go to the doctors and hospitals they want to go to in the upcoming year,” she said.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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That’s according to a document KFF Health News and Cox Media Group obtained through a Freedom of Information Act request.

Acting Commissioner of the Social Security Administration Kilolo Kijakazi read aloud from the document during the hearing but repeatedly left out an entire category of beneficiaries displayed on the paper as well.

The document indicates the fallout from Social Security overpayments and clawbacks is much wider than Kijakazi acknowledged under direct questioning from a House Ways and Means subcommittee that oversees the federal agency.

In a statement for this article, SSA spokesperson Nicole Tiggemann described the numbers of people Kijakazi provided in her testimony and those she left out as “unverified.”

“We cannot confirm the accuracy of the information, and we have informed the committee,” Tiggemann said.

The numbers “were gathered quickly,” the spokesperson said. Social Security systems “were not designed to easily determine this information,” she said.

After the October hearing, KFF Health News and Cox Media Group sent Tiggemann several emails asking her to clarify whether the annual numbers Kijakazi gave to Congress included all Social Security programs or just a subset. She would not say.

For answers, the news organizations several weeks ago filed a FOIA request.

Rep. Greg Steube (R-Fla.), a member of the subcommittee, said in an interview that he wondered if the agency “intentionally deflated the numbers to not make it look as bad as it is.”

“Maybe we should have her come back in for another hearing, put her under oath,” and ask her “why she wasn’t being completely upfront about the numbers,” Steube said.

Steube said that, when he heard Kijakazi’s testimony, he thought she was giving the subcommittee the complete numbers.

At issue is the scope of a problem that has terrified many Social Security beneficiaries and plunged them into financial distress.

As KFF Health News and Cox Media Group television stations jointly reported in September, the government has been trying to recover billions of dollars from beneficiaries it says it overpaid. In many cases, the overpayments were the government’s fault.

But, even in cases where the beneficiary failed to comply with requirements, years can pass before the government catches the mistake and sends a notice demanding repayment, often within 30 days. In the meantime, the amount the beneficiary owes the government can grow to tens of thousands of dollars or more — far more than people living month to month could likely repay.

The people affected may be retired, disabled, or struggling to get by on only minimal income.

The number of people experiencing overpayments is important to know because overpayments can cause a lot of harm, said Kathleen Romig of the Center on Budget and Policy Priorities, who worked in research at the Social Security Administration and has since spent 20 years in the field of Social Security policy.

“It should be a very high priority at the agency to produce more reliable numbers,” Romig said.

The Social Security Administration has long quantified overpayments in dollars rather than numbers of people affected. For example, the agency’s latest annual financial report says it recovered more than $4.9 billion in overpayments in the fiscal year that ended Sept. 30 and ended that period with a cumulative uncollected overpayment balance of $23 billion.

In September, SSA’s Tiggemann said, “We do not report on the number of debtors.”

In subsequent interviews with the news organizations, some lawmakers said the agency owed the public that information. “If they’re not telling you, I can assure you that’s a question that I’m going to ask in a hearing,” said Rep. Mike Carey of Ohio, the No. 2 Republican on the subcommittee.

At an Oct. 18 hearing, Carey brought up the number of debtors and told Kijakazi, “I think it’s something that we really need to get to the bottom of.”

Then he asked, “Do we have a number of how many people have been impacted by these overpayments?”

“We do,” Kijakazi replied. “And I’m, I looked at that before I came. I’m, I’m sorry. I’m not thinking of the number right now. But I can provide that.”

Carey pressed further.

“How many people are receiving overpayment notices in a year?” he asked.

At that point, Tom Klouda, a deputy SSA commissioner, got up from his seat behind Kijakazi and handed her a piece of paper.

Reading from the page, she gave two precise numbers: 1,028,389 for the 2022 fiscal year and 986,912 for the 2023 fiscal year.

When Carey asked if 986,912 “individuals were getting these letters in the mail saying that there was an overpayment and that they needed to contact you guys and set up a payment plan,” Kijakazi said, “That’s right.”

“Seems like an awful lot,” Carey said.

Under further questioning from Carey, Kijakazi repeated the numbers. She said they were “under Social Security” and “for Social Security.”

Subsequently, the agency declined to clarify what Kijakazi meant by that. Replying to a series of emails, Tiggemann would not say whether the numbers included all the Social Security programs.

Instead, she implied the agency didn’t know.

(WFTV, Orlando)

(KIRO-TV, Seattle)

“Again, our overpayment systems were not designed to easily determine the information you’re requesting,” she wrote on Nov. 29.

The document obtained via FOIA shows that the numbers Kijakazi gave at the hearing covered only two of the three Social Security benefit programs. They did not cover Supplemental Security Income, or SSI, which provides financial support for people who have little or no income or assets and are blind, otherwise disabled, or at least 65 years old.

On the paper that the deputy commissioner handed Kijakazi, overpayment counts for SSI appeared directly below the numbers she read aloud, and they were bigger: 1,118,648 people in fiscal 2022 and 1,189,642 in fiscal 2023.

The document is titled in part, “Overpayment Basic Facts.”

In the document, the numbers Kijakazi read at the hearing, which round to about 1 million people a year, are labeled “T2.” Title II of the Social Security Act covers two programs: Disability Insurance, or DI, and Old-Age and Survivors Insurance, or OASI.

The numbers Kijakazi omitted are labeled “T16.” Title XVI of the Social Security Act covers SSI.

Within the Social Security Administration, personnel use the term T16 when referring to SSI and T2 when referring to OASI and DI combined, said Romig, the former agency researcher.

It’s possible that some people who received overpayment notices through SSI also received notices through the other programs, leading to overlap between the numbers Kijakazi read at the hearing and those she didn’t provide, Romig said.

In the 2023 fiscal year, the agency paid SSI benefits to an average of 7.5 million recipients a month. Measured in dollars, the overpayment rate in SSI has been running about 8%, according to the agency’s latest annual financial report. That’s much higher than the half a percent overpayment rate for OASI and DI combined.

A written statement Kijakazi submitted to the House subcommittee included a clue that the numbers of people she gave the committee didn’t provide a complete picture. In the statement, dated Oct. 18, Kijakazi used the term “the Social Security program itself” to describe Disability Insurance and Old-Age and Survivors Insurance — but not SSI.

A press release the Ways and Means Committee issued after the hearing made no such distinction. “One Million Americans a Year Affected by Social Security’s Improper Payment Highlights Need for Reform,” it said.

(WPXI-TV, Pittsburgh)

(WHIO-TV, Dayton)

The document obtained via FOIA included other new information. It showed that relatively few beneficiaries contest overpayment notices and that many appeals or requests for waivers fail.

Weeks after KFF Health News and CMG television stations published and broadcast the first stories in their series, the Social Security chief ordered a review of overpayments.

In her statement Dec. 5, the agency spokesperson said that, as part of the review, the Social Security Administration is “looking at how best to inform the Agency, the public, and Congress about this workload.”

Do you have an experience with Social Security overpayments you’d like to share? Click here to contact our reporting team.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Jordan Rau, KFF Health News senior correspondent, moderated a Zoom event Dec. 5 about “Dying Broke,” an investigative project undertaken with The New York Times and Times reporter Reed Abelson about America’s long-term care crisis. Panelists shared their lived experiences of caregiving.

The event was hosted by KFF Health News and the John A. Hartford Foundation.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Why Hospital Monopolies Are a Bad Idea

I recently read the article about Ballad Health by Brett Kelman and Samantha Liss regarding the Mountain States Health Alliance and Wellmont Health System merging to create Ballad Health, upon state approval (“These Appalachia Hospitals Made Big Promises to Gain a Monopoly. They’re Failing to Deliver,” Sept. 29). Well, it was approved, and here is another reason that monopolies are a bad idea. My husband is a teacher in Tennessee, and it complicated our open enrollment selections for 2024 insurance. We have used BlueCross BlueShield of Tennessee, a widely selected insurer in our state. We were sent notification that Ballad Health and BCBST were in negotiations and that there was a high probability that Ballad will soon be an out-of-network provider for those with BCBST plans. Luckily, the school district offers Cigna insurance as well, but not all providers accept that insurance (as I said, BCBST is a huge insurer in this area).

Please explain to me how it is OK for a monopoly to decide not to be in-network with any health plans. They should be required to be in-network with any insurer from this area. I find this very upsetting. I shouldn’t have to worry that if a catastrophic event were to happen that my insurance coverage would be reduced to 60%-40% from 80%-20%, all because my only option for emergency care (Ballad) chose not to negotiate with the largest insurance provider in my area. Just food for thought.

— Kimberly Ensor, Johnson City, Tennessee

On X, formerly known as Twitter, a user whose tagline is “a one-woman wrecking ball” had this to say about nursing home worker shortages:

This is DEVASTATING! If CMS is saying they cannot identify a safe nursing staff level for residents than how can surveyors hold homes accountable? It ain't happening anyway. Biden's policy is WEAK. CMS is a joke. The gov't is throwing away $. Wash & repeathttps://t.co/1FZ0YRLfdm

— Politics, Policies & Pop Culture ✍️ (@out2sea90210) August 29, 2023

— Ashley Thomas, Cleveland, Ohio

The Crisis of Understaffed Nursing Homes

I wanted to thank you for providing a platform for discussion of nursing home staffing (“Exclusive: CMS Study Sabotages Efforts to Bolster Nursing Home Staffing, Advocates Say,” Aug. 29). As a nursing student entering my final semester at SUNY Downstate, I have seen firsthand the destitute conditions of understaffed nursing homes. Staffing ratios are abysmal and, as I see it, the only solution for the well-being of nursing home residents is a responsible staff-to-resident ratio.

I wholeheartedly agreed with the sentiment of the article: The Abt Associates study was a shameful attempt to undermine the movement toward standardized staffing ratios at nursing homes. People become residents at nursing homes for many reasons, but the fact is they are there, above all, because they need specialized care, which these homes need nurses to provide — services such as ventilator care, tube feedings, medication, continuous monitoring, and frequent interventions to prevent pressure injuries, and so much more. There is something terribly wrong when nursing homes cannot provide the services that define them, especially when families and residents depend on them to do so.

I do think there were some missed opportunities in the article. For example, Jordan Rau writes that “immobile residents are not repositioned in bed, causing bedsores that can lead to infection.” While this statement is true, it is rather vague. Infections are a life-threatening risk associated with pressure injuries, but the sores themselves are grotesque and painful, a point I think should have been included to emphasize the injustice of allowing pressure injuries to develop and worsen. Health care workers should make every effort to prevent them. And nurses should understand their roles as advocates in being a voice for patients who are unable to speak for themselves.

It’s easy for the public to imagine the residents of nursing homes as homogenous and stereotypical elderly people who have been forgotten as they became burdensome, which is not only false, but actively harmful and agist. People of all ages and backgrounds live in nursing homes, and their needs are as diverse as they are themselves. The only universal commonality they have is that they live in nursing homes and need respect, dignity, care, and an adequate number of nurses and staff to protect these needs.

— Tara L. Clark, Freeport, New York

A union activist who supports a national single-payer health system also weighed in on X:

CMS is the agency that is supposed to protect patients. But CMS, instead, follows the bidding of the nursing home industry. Shame! This is the same agency that presides over handing Medicare to the for-profit industry. https://t.co/xYpKySzkwJ

— Kay Tillow (@KayTillow) August 29, 2023

— Kay Tillow, Louisville, Kentucky

Avoiding Financial Ruin for Aging Elders

As Jordan Rau and Reed Abelson identify (“Facing Financial Ruin as Costs Soar for Elder Care,” Nov. 14), too many of today’s older adults are falling through the cracks. They may struggle with daily activities and declining health but don’t necessarily need 24/7 nursing home care.

Within the patchwork of long-term care, the Program of All-Inclusive Care for the Elderly is underutilized. PACE offers integrated care through its campus-based model, where participants can receive comprehensive, coordinated medical care and social services in a combined Medical Clinic and Day Center, while also receiving at-home support with essential tasks like dressing, bathing, and eating.

This care is free to our dually eligible participants who are never saddled with copays, out-of-pocket costs, or deductibles. PACE has saved states thousands annually per participant. Further, participants are grateful to stay at home and remain engaged with family and friends.

PACE acts as a critical safety net for low-income seniors, so they and their families aren’t forced into financial ruin. For those not Medicaid-eligible, it costs less than the nursing home alternative.

To close our system’s gaps and lower spending, programs like PACE need to become a more prominent part of the discussion. Policymakers should expand access to PACE services so more people can benefit from this successful model of senior care.

— Richard Fish, CEO of One Senior Care, Erie, Pennsylvania

JoAnne Dyer echoed the dire warning about the draining cost of long-term care in an X post:

Something scary that you're probably not thinking about but you probably should be thinking about. Long-term care can bankrupt you. Yes, you. You with your savings account and your 401k. https://t.co/OsaztigioN

— JoAnne Dyer (@7Madronas) November 15, 2023

— JoAnne Dyer, Seattle

More Power to Suzanne Somers

Age 76 is pretty long to fight an aggressive, metastatic breast cancer without chemotherapy (“Suzanne Somers’ Legacy Tainted by Celebrity Medical Misinformation,” Oct. 18). I’d say Suzanne Somers proved her point! None of us lives forever. I got a lumpectomy in 2015 and refused tamoxifen. Chemotherapy wasn’t needed. I refuse mammograms and gynecology. I am doing well. I found Ms. Somers’ book on cancer, called “Knockout,” very informative. I didn’t buy into the supplements angle, but it empowered me in my own fight, when there were no answers, to ask questions and research. Quality of life is more important.

— Kerry McCracken, Milan, Illinois

A Las Vegas reader reacted on X to the same article published by the Los Angeles Times, one of California Healthline’s media partners:

Ruthless Progressives and their corporate media trolls will continue to hate you long after you're dead and buried.https://t.co/BF3y1v1gki#Progressive #hate #corporatemedia #disinformation

— Grant David Gillham 🐎🗡️🌊🛩🔫🇲🇽🏍⛳🎸 (@CaptG2) October 19, 2023

— Grant David Gillham, Las Vegas

Over-the-Counter Narcan a Big Leap for Humankind

Thank you for sharing your article highlighting barriers to accessing Narcan (“Narcan, Now Available Without a Prescription, Can Still Be Hard to Get,” Oct. 6). While some experts have questioned the significance of making Narcan available over the counter, I firmly believe this development is a major milestone in our ongoing battle against opioid-related fatalities.

One may argue that this change is merely a “tiny, tiny baby step” and not deserving of applause; however, I would contend that every positive change, no matter how small or late in the game, is a vital part of a larger solution. Making Narcan available without a prescription is a tangible acknowledgment of the urgency of the opioid crisis and a recognition of the need for swift, accessible interventions.

Narcan’s OTC status can help reduce the stigma surrounding opioid overdose and encourage open conversations about addiction and harm reduction. It sends a message that saving lives is a priority, and it encourages individuals to be prepared to act in emergencies.

Still, there are certainly challenges related to affordability of OTC Narcan. While $45 isn’t an ideal price tag, community groups, first responders, state and local governments, and harm reduction groups — many of whom may purchase Narcan in bulk — can buy Narcan for a cheaper price, $41 per two-dose carton.

It is also important to continue educating pharmacists on the use of Narcan. Only 19 states require that pharmacists complete a training course prior to dispensing naloxone in any capacity. All pharmacists, especially those located in areas with high rates of opioid deaths, need to be firmly equipped with the necessary information on administering Narcan to be a trusted source among the public. Provider education is a key steppingstone to improving access.

Narcan’s OTC availability represents a positive shift in our approach to combating opioid overdoses, and it is a step that deserves acknowledgment and support. Let us not underestimate the impact of this change and continue working toward a future where every person has access to the tools they need to prevent opioid-related fatalities.

— Sana Imam, master’s student at George Washington University, Washington, D.C.

The HIV Prevention Trials Network chimed in on X:

As an over-the-counter product, Narcan ideally would appear on store shelves in the same way as ibuprofen and cough medication. https://t.co/fkzCZfwgFL

— HPTN (@HIVptn) October 11, 2023

A ‘Hit Piece’ on Rival Hospital Systems

I recently read your article of a couple of years ago comparing for-profit versus nonprofit medical schools (“Montana Med School Clash Revives For-Profit Vs. Nonprofit Flap,” June 7, 2021). I am an anesthesiologist with 24 years of experience, and almost every health care institution or hospital has become for-profit. In fact, most anesthesiology groups are managed by corporations like NorthStar Anesthesia, U.S. Anesthesia Partners, etc. Hospitals have merged into gigantic multibillion-dollar corporations like Ascension, Universal Health Services, HCA Healthcare, and CHI Health.

So why is it so bad to have a for-profit medical school, exactly? Almost every aspect of modern health care has become for-profit, and those nonprofit institutions have colluded with larger systems to shut down smaller hospitals. So this clearly is a “hit piece” on the for-profit educational system by their competitor, Touro College and University System.

I am one of the few doctors truly trained in a nonprofit — called the U.S. Army, where I did my residency in anesthesiology at Brooke Army Medical Center. This is quite an uninformed and unreasonable article, especially given the state of the corporate health care industry that is pervasive in our country. When I left the military for private practice, I could not believe what was being passed for elective surgery outside the military.

So let’s not get the pot and kettle confused here. Calling out a for-profit medical school in an era dominated by large multibillion-dollar health care corporations is certainly the pot calling the kettle black. And the rural Montana area is just as much of a deserving area for any medical school — for-profit or nonprofit — as the rural state of West Virginia, where I practice.

— Lance R. Hoover, Morgantown, West Virginia

Medicare Cuts Harm Seniors’ Access to Physical Therapy Care