Government Accounting Office Reviews Social Security Disability Program
Fraud in the Social Security Disability (SSD) program has been the focus of many investigations as of late. The most recent report comes from the Government Accounting Office (GAO).
Why the GAO Reviewed the SSD program
The U.S. Senate Committee on Finance and the U.S. House of Representatives Committee on Ways and Means requested that the GAO review the Social Security Administration's (SSA) policies and procedures for fraud detection. This request was made due to a number of high profile arrests and indictments for Social Security Disability fraud perpetrated by some doctors and former SSA employees.
The GAO issued the report: SSA Disability Benefits: Enhanced Policies and Management Focus Needed to Address Potential Physician-Assisted Fraud. The GAO reviewed the Social Security Administration's “policies and procedures in place for detecting and preventing fraud with regard to disability benefit claims.” The GAO pointed out that “SSA has launched several initiatives to detect and prevent potential fraud, but their success is hampered by a lack of planning, data, and coordination. For instance, SSA is developing computer models that can draw from recent fraud cases to anticipate potentially fraudulent claims going forward. This effort has the potential to address vulnerabilities with existing fraud detection practices by, for example, helping to identify suspicious patterns of medical evidence. However, SSA has not yet articulated a plan for implementation, assigned responsibility for this initiative within the agency, or identified how the agency will obtain key pieces of data to identify physicians who are currently not tracked in existing claims' management systems.”
The GAO pointed out that the SSA relied too heavily on their staff who review SSD applications to be the first line of defense in detecting fraud. “SSA's guidance instructs front-line staff to identify suspicious patterns of medical evidence—such as boilerplate or similar language from the same physician across multiple claims—as well as other factors that may indicate potential fraud. However, SSA regional officials, Disability Determination Services management, and front-line staff said that it is difficult to detect these patterns because staff may review claims originating anywhere in the state or across a large geographic area, leaving it in part to chance that staff would see evidence from a single physician on more than one claim. As a result, DDS staff stated that they must rely on coincidence—such as the receipt of consecutive claims with evidence from the same physician—to be able to identify a suspicious pattern.”
The GAO recommended that SSA staff receive more training and incentives to detect and prevent physician-assisted fraud. Another recommendation is to remind SSA staff to report all potential fraud to the SSA Office of Inspector General. The GAO also suggested to making changes to policies and procedures related to sanctioned physicians. The SSA is putting in place computerized tools known as predictive analytics. The GAO pointed out that this process is in the early stages and its ultimate success is unknown.
How the SSA might possibly implement these changes is unknown, but the SSD program is still in place and requires a lot of documentation when applying for benefits. If you are considering applying for disability benefits, contact our experienced attorney to assist you.