Sep 17, 2014

An OIG "Special Report"

     Social Security's Office of Inspector General (OIG) has issued a "Special Report" on The Social Security Administration's Ability to Prevent and Detect Disability Fraud. There are some small bits of news in the "Special Report" but it's mostly a stale rehashing of old news in an attempt to placate Congressional Republicans who want proof that fraud is rampant in Social Security's disability programs. Three isolated instances of alleged small scale schemes to defraud Social Security do not constitute proof of rampant fraud. It's merely a sign that there are stupid people who make the mistake of thinking that it's easy to defraud Social Security.
     Anyway, here's the few nuggets of news that I found in this "Special Report":
  • "The Acting Commissioner and others have consistently and inaccurately cited a 2006 OIG report as the “best-available evidence” that the rate of fraud in the disability program is less than one-tenth of one percent. We are currently updating that 2006 report, and expect that our findings will give us more insight into fraud and abuse in the disability programs." Later in the report, OIG says, basically, that even though there's a report they issued some years ago that can be interpreted in the way that the Acting Commissioner interpreted it that she shouldn't have because maybe there are some overpaid claimants that OIG doesn't want to prosecute but who OIG still wants to label as fraudsters. Is it reasonable to call something fraud if you're not willing to prosecute it as fraud?
  • "The Agency’s dated systems, combined with the diverse and unintegrated systems of 54 DDSs, provide little protection against the cookie - cutter approach to large - scale DI fraud conspiracies such as those in New York and Puerto Rico, where only vigilant DDS analysts were finally able to detect signs of a scheme after millions of dollars were paid to fraudulent beneficiaries."
  • "This year, SSA began an initiative to develop predictive analytics to detect disability fraud."
  • "SSA is currently working with three vendors: Northrup Grumman and SaS on the use of the predictative analytics tool, and Accenture regarding a joint anti-fraud unit."
  • OIG has noticed that scanned images of documents don't contain searchable fields, meaning it's impossible to turn the powerful software that Northrup Grumman and SAS wants to sell the agency loose on all those scanned documents so why is the agency considering buying the software? That means that humans, who are actually pretty good at noticing patterns, will probably have to be the ones noticing the patterns.
  • OIG wants "a comprehensive tracking and review process for all claimant representatives."
  • "SSA is currently working with the Disability Researth Consortium and the Library of Congress in a literature review to look at how other disability systems factor in age, education and work history. The agency intends to update the vocational grids, used to establish disability and to identify other work that a claimant could perform."
  • "In FY 2007, 19.6 percent of ALJs allowed more than 85 percent of their cases; in FY 2013, that percentage dropped to 2.9% of ALJs ..." What does this have to do with fraud? Also, did the percent of ALJs denying a huge percentage of the cases they heard go down in a similar way?

15 comments:

Anonymous said...

SSA is ignoring the fact that they receive millions of documents with searchable text today and have been for well over a decade, but convert those documents into scanned images of documents. They are also missing what has been happening within healthcare with the adoption electronic health records in which structured and searchable text is available in medical records. Again they convert these documents into scanned images of documents. Quite a large opportunity.

Anonymous said...

There is both large scale fraud and small scale fraud. If the agency is unwilling to prosecute small scale fraud, it can turn into large scale fraud. This is the "Broken Window Theory".

Anonymous said...

SSA should discontinue face to face ALJ hearings. These hearings likely
lead to improper decisions based on a claimant appearance.

For example: An old male ALJ has hearing with young attractive female claimant. Old ALJ allows claim based on little evidentiary support.

Example two: An old white ALJ has hearing with a young black male. Old white ALJ deny black claimant because he believe black claimant is a bum and a thug without evidentiary support.

Anonymous said...

I've made this point before, but it bears repeating:

Just because OIG doesn't pursue or prosecute claims on the basis of fraud, does NOT mean that fraud isn't occuring.

all it means is that the costs of prosecuting the fraud likely exceed the benefits of persuing the case on an individaul basis. Case in point, claimant is getting paid under the table to paint houses and doesnt report it. fraud? absolutely. Will OIG investigate if his neighbor turns him in? unlikely.

Anonymous said...

8:32, do you have a shred of evidence that that kind of bias exists in ALJ decisionmaking?

Anonymous said...

This is 8:32 AM, September 17, 2014

NO. Every human is capable of a preference or otherwise bias in their decisions(non ssa decisions),and the history of the U.S.A(discrimination against women,people of color such as blacks)suggest discriminatory practices are possible in america. SSA may not have done a study for the pattern,therefore no evidence.

Anonymous said...

8:32 - To make such an inference is, at best, tenuous. What's more, to use that as a reason to DISCONTINUE face-to-face hearings (in effect, a major overhaul of disability adjudication) is an absurd notion.

Anonymous said...

This is 8:32 AM again.

Although not directly supporting a belief of biased ALJ decision making. The following link certainly lend partial support to my position for abolishing face to face hearings.

http://www.mercurynews.com/education/ci_26549432/racial-awareness-studies-win-stanford-prof-genius-grant

Anonymous said...

8:32 AM

If you paid money for your education, then find an attorney to help you sue for your money back. Your logic is bad and you should feel bad.

Anonymous said...

Old reports, but relevant:
http://www.gao.gov/products/GAO-02-831
http://www.gao.gov/products/T-HRD-92-41

Anonymous said...

What a crock.
After cautioning, that their previous reports should be taken with a grain of salt they rehash old New York and Puerto Rico news. Throw in photos of Ponzo in cuffs and a person in a boat with a fish, season with suggestions that “SSA Develop routine computer matching to identify high-allowance ALJs and any connections to the same claimant representatives and/or doctors/medical facilities”
No priority for the high denial judges, I guess.
No discussion of underpayment.
Reads like it was written by Congressman Sam Johnson who they quote.
Why not come back when you have something. This reads like a fraud campaign, not an objective report. OIG should be embarrassed to release rehashed agenda drivel like this.

Anonymous said...

Well, I am a white ALJ. I was discriminated against based on race and filed and won an EEOC case based upon the discrimination. Quit picking on old white men, they are not the villians of the world.

Anonymous said...

ALJs get to decide "credibility" - and if anyone believes that ALJs don't have biases, then he or she has been raised on another planet. I can definitely see a white male ALJ finding a young, attractive, middle class female "credible" and then finding an indigent person of color (with a similar impairment) not credible. ALJs have too much discretion in these claims, which should be evaluated like insurance claims and not court cases.

Anonymous said...

First, everyone has a bias. There is nothing wrong with having a bias, it is prejudice or the inability to overlook your bias that is a problem.

Second, if you think a bias cannot be overlooked, then face-to-face criminal and civil trials should be out, as should job interviews and school and just about everything else.

Third, if the credibility determination was removed from the process, such that a finding of disability was purely a medical determination, similar to whether a claimants impairment meets a Listing, then the number of "pay" cases would drop extremely low -- extremely low.

Anonymous said...



I agree with 8:59 PM, September 18, 2014. SSA should treat applications for disability like insurance claims. Seemingly in opposition,previous poster's comment state"face-to-face criminal and civil trials should be out",but those are ADVERSARIAL proceedings.

Using the previous poster's logic,a claimant would also be entitled to a jury verdict.

The Social security administration and certain DISADVANTAGED claimants would be best served if SSA abolished face to face hearings and replaced ALJS with state level adjudicators,with state level salary,who would decide each appeal based on the additional evidence submitted.

Perhaps claimant reps can advocate this position through NOSSCR.