SSA Office of the Inspector General Stepping Up Fraud Investigations
Social Security Disability (SSD) has come under fire lately on accusations of massive fraud. There is an investigation going on in West Virginia and Puerto Rico by the Social Security Administration's Office of the Inspector General (OIG). After news reports about an attorney and administrative law judge collaborating to approve disability claims, some in Congress, like Sen. Tom Coburn, R-Okla., are calling for major reviews of all disability recipients to weed out improper payments. OIG Investigation With all of this scrutiny, the OIG issued a press release that they are stepping up investigations of fraud. OIG notes that disability decisions are made by reviewing reports issued by “licensed medical professionals, attorneys, non-attorney representative, interpreters, and social workers.” These individuals are known as third-party facilitators and are welcomed in the disability process to assist individuals through the claims process. While OIG is always on the lookout for fraud by third-party facilitators, they announced they are increasing their scrutiny of complaints. “In the current fiscal environment, it's even more critical – and more difficult – to make sure that only those who are eligible for benefits can receive them.” But now they are stepping up their efforts to identify fraudulent claims and take action in those cases. OIG's press release notes some of their most recent fraud investigations in San Diego and Puerto Rico. Investigations OIG points to its investigation of a San Diego area clinical psychologist who falsified medical reports for dozens of patients to say that the patients were disabled. For a fee, the psychologist “made up patient histories, fabricated test results, suggested symptoms and complaints that did not exist, intentionally underestimated patient scores on standardized tests, and lied about the length of time he had been seeing patients.” The psychologist was sentenced to 21 months in federal prison and ordered to pay $1.5 million in restitution to the Social Security Administration (SSA). In August 2013, the FBI and OIG announced a Federal Grand Jury in the District of Puerto Rico issued indictments of three doctors, one non-attorney representative, and 71 other social security claims for fraud. The investigation took two years and “focused on historical claimants, whose claims were medically supported by suspect physicians.” The suspect physicians received payments for medical reports fabricated to persuade SSA workers to award disability payments. Aside from civil forfeiture of $1.7 million and other valuables from the doctors involved, the SSA is seeing repayment of more than $2.1 million from those who illegally received SSD benefits. SSA Fraud Investigation Program The SSA already has a fraud investigation program in place, the Cooperative Disability Investigation Program. The OIG pointed out that there are “25 CDI Units across the United States, that have helped save a projected $1.5 billion for SSA's disability programs.” A new pilot program is being implemented to expand the CDI program to focus on allegations of third-party facilitator fraud. While the recent SSA investigations, news reports about SSD insolvency, and news reports of rampant fraud may make one concerned about the status of the Social Security Disability program as well as their own benefits, contact our knowledgeable attorney to review your case and protect your rights.