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HRD-85-37 1 (1985-02-27)

handle is hein.gao/gaobabnpd0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 14UMAN tR9OUftCU DIVISION B-211212 FEBRUARY 27, 1985 The Honorable Robert Gielow Chairman 110 l Railroad Retirement Board 126303 Dear Mr. Gielow: Subject: Need !to Improve Internal Controls to Curtail Possible Fraud and Abuse in the Railroad Retirement Board's Unemployment and Sickness Insurance Program (GAO/HRD-85-37) We have completed our assessment of the Railroad Retirement Board's controls for preventing and detecting fraud and abuse in its unemployment and sickness insurance program. This program has paid out about $1.4 billion in benefits during the last 5 years to 1 million qualified rail workers who become unemployed or are absent from work due to sickness. Rail employees who claim unemployment or sickness benefits while they are working, either in the rail industry or else- where, may be guilty of fraud or abuse. In deciding whether fraud was involved, the Board considers, among other things, whether the applicant knew what was required and intended to deceive. If knowledge of the requirements and intent to defraud the program cannot be proved, the Board does not classify the case as fraudulent but does move to collect the overpayment. Such cases are generally considered abuses of the program in that they are caused by claimants and result in improper pay- ments. Our review did not include all possible aspects of control over fraud and abuse in the Board's unemployment and sickness insurance program. Rather, we limited our review to the possi- bility of persons (1) working in rail or nonrail employment while collecting unemployment and sickness benefits, (2) commit- ting fraud by claiming benefits on the basis of another bona fide rail employee's work record, or (3) submitting sickness in- surance applications containing false doctors' certifications. We identified opportunities for the Board to improve its con- trols for preventing and detecting fraud and abuse in such situ- ations. (105210)

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