Feb 15, 2017

Report On DQ Reviews -- And I'm Not Talking About Dairy Queen!

     For some years, the Division of Quality (DQ) of Social Security's Office of Disability Adjudication and Review (ODAR) has reviewed a small number of Administrative Law Judge (ALJ) decisions granting disability benefits prior to effectuation of benefits. Some decisions are overturned as a result of these reviews. A recent report by Social Security's Office of Inspector General (OIG) looks into these DQ reviews. Here's the bottom line of the OIG report:
Overall, about 5 percent of the total PER [Pre-Effectuation Review]  cases processed in FY [Fiscal Year] 2011 led to a denial or dismissal. Given the rate of denials and dismissals, we estimated the potential net program savings ranged from $23 to $25 million for that year. Overall, the Agency saved $4 to $5 on average per $1 spent on the PER process in FY 2011.
     There's one big problem with these DQ reviews -- there's zero proof that DQ possesses the gold standard for determining who is and who isn't disabled. You could save money by randomly overturning ALJ decisions that approve disability claims with no less validity.  No one has a gold standard for determining disability.
     By the way, take a look at this table from the report (click on it to view full size):
      Notice the decline in dispositions at the same time as the agency's backlogs were increasing. Note also the much more dramatic decline in the number of favorable decisions. The 2010 election brought GOP control to Congress. The laws weren't changed but the climate at the agency changed dramatically. Backlogs were no longer a big concern. Denying as many cases as possible became a good thing. Anything like DQ that would cause more claims to be denied received favorable attention.
     In any case, I'm going to keep repeating, DQ isn't the repository of the gold standard for determining disability. There is no gold standard. DQ is a waste of money unless your goal is denying more claims.

19 comments:

Anonymous said...

Strangely, DQ appears to interfere with judicial independence, does it not???

Anonymous said...

I would be interested in the results from a similarly performed review of cases which were denied by ALJs.

Anonymous said...

Cases denied by an ALJ are brought by claimant's and there reps alleging mistake during the hearing. An argument is presented (somewhat) and the Agency looks for mistakes in the denial, which may have many, considering that the Rules, Regulations, Statutes, policies, etc, are conflicting confusing and contradictory. Based upon the mistakes, and the appealing party, a hearing may be remanded or in very few cases overturned by the Agency. This is due process. The purpose of the ALJ is to allow a claimant redress from a bad decision of the Agency to allow the Agency to then decide an allowance by the ALJ is improper is interference with judicial independence and smacks of malfeasance on the part of the Agency.

Anonymous said...

The agency has been very successful at going after high paying judges who failed to properly weigh evidence, follow the law, etc. However, the agency never seems to go after the low paying outliers who, in many cases, get remands for the same mistakes over and over again, abuse claimants/representatives, and sometimes make up their own disability standard out of whole cloth. While Congressional subcommittees have talked about the cost that high paying judges who improperly approve benefits, how much does it cost the agency in terms of manhours, etc to rehear a wrongfully denied case sent back by the AC, or after an FDC remand (think the cost of attorneys at the FDC level, EAJA fees, man hours conducting a new hearing, paying experts again, etc).

Anonymous said...

It lines up with the appeals council remand rate. About 5%. It's almost like they overturn the same percentage of cases whether or not it is favorable or unfavorable.

We have some good cogs up there in that high tower.

Anonymous said...

@10:11

ALJs do not have judicial independence.

Anonymous said...

I AM REP! PAY ME! HEAR ME ROAR!

Anonymous said...

If the Agency cared about claimants, they wouldn't remand back to the same Judge... And NOW you tell me that ALJs don't have judicial independence.... DAMN APA.. Damn Agency...

Anonymous said...

DQ reviews do not consist of using some "gold standard" of disability to second-guess ALJ judgments. That is a straw-man argument and betrays a lack of understanding of what a DQ review actually does. ODAR is in the business of mass-producing decisions (deboning chickens if you will) and it does happen that cases go all the way through the assembly line with flaws in them: an incorrect DOB may have led to the wrong grid rule being used; a medical source statement may have been overlooked or literally misinterpreted (effectively read "not disabled" as "disabled"), etc. QR points out such errors and the case then goes back to the ALJ to address - and not necessarily resulting in a pay being changed to a denial. For instance if a case goes back to an ALJ to address a missed MSS, the ALJ can sustain the original pay decision by giving little weight to the missed MSS.

One could argue QR is a waste of money if it weren't returning its investment but with a ROI of 300%-400%, this post is nothing but whining that there is no such thing as a "Bank Error in Your Favor - Collect $10" Community Chest card for claimants. When ODAR makes errors that prejudice the claimant, there are multiple mechanisms up to and including the Supreme Court to ensure justice is done. When ODAR makes errors that prejudice the taxpayer, it's illegitimate to even try to correct them?

Anonymous said...

Some inconvenient evidence for the tinfoil hat crowd that thinks there has been a conspiracy afoot since 2010 for an agency of a completely Democratic-controlled executive branch to all of a sudden start taking its orders from one half of one house of Congress: QR attorneys (and other resources in the agency) are being retasked to the writing backlog. That's right: despite Republicans now controlling both houses of Congress and the White House, the agency is moving in the exact opposite direction from "denying more claims." Sorry to disappoint.

Anonymous said...

Wait ya 'all... Until Tommy gets to take swipe at a..... As in Lappert

Anonymous said...

@4:20,

DQ should not be confused with Quality Review, which randomly reviews draft decisions after they have been moved into EDIT in CPMS, that is, before the ALJ has reviewed the draft and signed it. On the decision writing call, DQ staff (Are they attorneys? They sound like Operations folks.) were not listed as having been returned to decision writing, assuming any of them do have a writing background.

Anonymous said...

There's a whole bunch of sick white folks in the rust belt, down south and out west who are in the Trump Army and have concluded they are republicans. They love the program for themselves and their relatives, but not the crazy down the street or those lazy minorities. When they were getting denied before it was that Muslim in the white houses fault that has all changed. Deny them at your own risk. When is the next election? I have represented entire Tea Party families or clans over the past few years. Big government isn't big if it is directly helping them--it is big if it is addressing the other guy's problem. Don't Tread on Me.

Anonymous said...

8:01 Right on Bro. The irony of it is.. those who put this guy in the WH (W here dosen't stand for White)..will get screwed Hugely..whether it is ACA,Disability,Medicare or another program. If they were angry before wsit until he is done with them. Hint: Tjus time It aint gonna take 4 years.

Anonymous said...

What's the saying, statistics lie and liars use statistics? DQ is a numbers game and if an independent consulting firm - like Booz Allen, for example - looked at it closely, without the kind of self preservation bias that agency insiders have, the results would be different.

Doubtful, that the insiders in OIG factored in the all labor and associated costs (equipment, leasing, materials) that have been spent in reviewing a sampling of favorable decisions -- which can involve hours of work by multiple attorneys from analyst to appeals officer to two or three AAJs, plus the costs involved in remanding the case back to the hearing office to redo the case, which again involves multiple attorney and alj hours and leased space, equipment, expert testimony costs, etc. There is no way OIG counted up all the costs of the system accurately.

Unsustainable system that's crashing in on itself.

Anonymous said...

DQR is a branch of the Appeals Council consisting of 9 divisions of "Hearing and Appeals Analysts" and a few AAJs in Falls Church/Crystal City probably a mix of paralegals and mostly attorneys. It doesn't really matter paralegals and attorneys are functionally equivalent in ODAR. Any notion that attorneys have some sort of additional ethics in their back pocket is nonsense. Decisions that matter are made above our head. Between the 9 divisions there are about 100 of these people.

There was no indication that they would be writing, CALJ was referring the much smaller QR staff (like 5-8 people per region) that is part of OCALJ that would be writing.

Anonymous said...

lol @ judicial independence

ALJs cannot set precedent, make equity decisions (save for a very small handful of instances related to nondisability issues), etc. Their QUALIFIED judicial independence lives within the walls of the law, regulations, and internal agency policy. Too many folks, mostly ALJs, forget this.

Anonymous said...

oh snap!

@9:52AM just dropped the mic and walked off the stage

Anonymous said...

@10:43 and 1:16, right on!!