Social Security Establishes New Fraud Detection Program

Fraud in the Social Security Disability program has been in the news a lot lately. From the scandals in Puerto Rico to New York City, a need for fraud prevention and detection has been identified. Carolyn W. Colvin, Acting Commissioner of Social Security, announced on March 31, 2014, that the Social Security Administration was opening a new fraud prevention unit in New York City.

Puerto Rico Case

In August 2013, 75 people were indicted in Puerto Rico on charges of fraudulent medical claims for Social Security Disability (SSD). The individuals who received the fraudulent SSD claimed they had disabling psychiatric conditions or serious back or cervical pain. During a two-year investigation, officials reviewed “hundreds of surveillances and painstaking analysis of medical records.”

The scheme was organized by a Social Security worker and three doctors. The former Social Security worker received 25 percent of the recipients' lump sum payments.

New York City Case

Police officers and firefighters are held in high esteem for their service to their communities. But in January 2014, a group of 106 retired New York City police officers and firefighters were indicted for defrauding the federal government. These individuals were accused of receiving Social Security Disability payments when they were healthy and even held down private employment. According to the indictment, these individuals collected more than $21.4 million in disability benefits.

This scheme dated back to 1988 and involved as many as 1,000 people. Four individuals organized the scheme and received kickbacks when individuals received their first disability payment.

New Fraud Unit

The Social Security Administration established the new unit “to identify potential fraud and detect fraud trends that can be applied to disability cases nationwide. This unit consists of experienced disability examiners who are currently involved in the re-review of disability medical decisions resulting from recent indictments in Puerto Rico and New York City. Using their specialized experience, they will collaborate with Social Security systems personnel to help build data analytics to detect and prevent fraud at the earliest possible point in the decision-making process.”

Commissioner Colvin stated that the current Social Security “anti-fraud approach has resulted in a fraud incidence rate that is a fraction of one percent.” The new unit “will start with 20 disability examiners” stationed in Jamaica, New York. “Based on the trends found in the Puerto Rico and New York cases, along with further analysis of doctors' reports, the unit will use their findings to create the systems and data analytics that Social Security will use for disability applications nationwide. As these systems develop and begin to identify new cases of potential fraud, the New York fraud prevention unit will analyze those cases to prevent fraud from happening before the agency makes a disability decision and authorizes payments.”

This new fraud unit will be making suggestions to update the SSD application process. It is possible that required forms may change and additional information may be required for submissions. SSD applications already require extensive documentation on an applicant's medical condition. If you are considering applying for disability benefits, contact our experienced attorney to assist you.