Would it be possible for a hearing office at Social Security to enter a decision in Social Security's computer system as having been made when no decision has actually been issued? Could that computer entry cause payment of benefits? Is it conceivable that a hearing office could delay issuing a written decision -- either an allowance or a denial -- for months after entry of a notation in Social Security's computer system that a decision had been made? Who would be responsible if such a thing happened? Who would know about it?
Addendum: How can I receive a fee check (not direct deposit) on November 23 on an Administrative Law Judge decision that bears the date on its face of November 17 unless that decision was implemented without an electronic signature?
Addendum: How can I receive a fee check (not direct deposit) on November 23 on an Administrative Law Judge decision that bears the date on its face of November 17 unless that decision was implemented without an electronic signature?
There is no connection I know of between the actual decision and the issuance of a paper notice. The inputs for an allowance, etc, are separate from the decision process and the paper needed to record the decision. People who are still in SSA should check the current validity of this statement, but you can build a completely non-existent claims file purely with systems inputs and have always been able to do so. In the 1980's and 90's, there were several cases of fraud in DO's in California involving employees who faked folders, invented claimants, and happily garnered the benefits thus obtained. Also, various manual payment systems can pay out benes to imaginary claimants (yes, it happened in BDI in the 80's.)
ReplyDeletePlease correct my information regarding claims allowance inputs if the system has changed. But, the payment system is not designed to detect or prevent the obvious "fake claimant" fraud described above. We are supposed to have quality reviewers to do that. QED. Nancy Ortiz
Hah! I called ODAR by its antique name of BDI. Boy, please nip in and correct what may be information as bad as the acronym! Nancy O.
ReplyDeleteYes. The computer system will not close an electronic decision (almost all disability decisions now) until a decision has been electronically signed, but the computer does not physically issue/mail the decision. There is a Central Print function that is supposed to automate that, but it has major glitches. So human or computer error could result in no decision having been "issued," even though the decision exists. (The decision has to exist for the case to close in almost all cases.)
ReplyDeleteNo. Nothing gets paid until the nice folks in the Payment Centers physically check and approve.
My point is that the nice people in the payment centers can do what they want by dummying up a claimant. And so could FO people up to a point. All SSI claims are paid out in the DO's. And, as a result, fraud is very possible at that level. As is payment outside the system via TPPS and in the PSC the manual processing system. Our reviews are manual and depend on paper processes. So, things can slip through just based on the volume of work produced.
ReplyDeleteI am focussing not on what is supposed to happen but what can happen, assuming employees have a criminal inclination. Nevertheless, I appreciate Anonymous' excellent information and expert knowledge. Thanks for the help. Nancy O.
Nancy is a dinosaur. The process used in the 80's is not relevant to our current electronic process (and BDI is not an old name for ODAR it is the old name for ODIO). A check cannot be issued by any input done in ODAR.
ReplyDeleteThere is no indication this question is about an attorney seeking fraudulent payment, or an employee colluding with an attorney to issue a check not due. The entire issue of fraud is irrelevant and based on antiquated assumptions.
As an SSI CR in an FO, I could create a false MSSICS input that would result in an SSI payment for a claim that had been denied, is still pending, or never existed. I probably wouldn't sleep for weeks, but I know how to do the input. But I don't know the answer to the original question about an input done by ODAR.
ReplyDeleteI love being a dinosaur. However, A#3 understands my point. Think about making money at the company's expense and you'll be likely to figure out a way. All's I'm saying. NO
ReplyDeleteIn the world of electronic claims, it is not uncommon for a field office to receive notice of the decision prior to the paper decision being generated/mailed. I have seen several cases where the "decision date" is several days before the date on the decision notice. If a field office is really on the ball and working those ALJ decisions as soon as they come through, the claim can be effectuated very quickly - especially if it is SSI only or has no offset involved.
ReplyDeleteOne of the reasons that AVID and hence the electronic signature was implemented was because a few HO clerks figured out a way to approve claims without a valid ALJ signature. NO is correct that where there is a will one will find a way.
ReplyDeleteThe comments I have reviewed thus far show a critical misunderstanding of the processing of ALJ favorable reversals. First of all, ODAR has no control over payment in any way, shape, or form. No matter what they did, it could never, ever establish benefit payments -- never has been able to, never will be able to. The ALJ decision represents only a portion of the entire disability determination. The "benefit decision" or "effectuation" is carried out in the payment center, or in most cases, ODO (PC7). It takes a claims authorization action to establish the record and begin payment, either through the automated Modernized Claims System or via transmission by the Manual Adjustments, Credits, and Award Process. That's not done in the D/O, in fact it cannot be. a CR's PIN cannot close a non-District Office Final Authorization claim. So, that addresses that issue.
ReplyDeleteSecondly, the ALJ's decisions, like all SSA notices, are forward-dated by about 5 days. If the ALJ inputs the electronic signature November 25 2009, the decision writer will date the notice November 30 2009. For a fully electronic case ODO will receive the case for processing the day after the ALJ e-signs the case. MCS will usually trigger a claim with a Run Process Date of the next day, check dated that day, meaning that the listed scenario is completely feasible.
IMO, there are too many checks and balances in place to prevent payments to fictitious DIB claimants WITHOUT THE ASSISTANCE OF A MEMBER OF THE PUBLIC. Now THAT I have seen several times, but never any schemes concocted solely by SSA employees.
SSA's systems reflect a summary of all actions taken. In SSI cases, system screens for authorized users, but cannot verify the existence either of an actual claim file or a claimant. The premise is that all inputs reflect actual actions.
ReplyDeleteIn DO's, one form of fraud practised in the past involved altering existing medical files of allowed cases (we have file cabinets full of them in the DO's) to correspond to the supposed claimants name, SSN, DOB. Do some whiting out, typein the new name,etc. yes, typewriters still exist in the DO's!)and you have a fictitious claimant.
Where is the claimant? Doesn't matter, it can be any non-entitled person. Send the file off to the DDS after you input the claims screens and you have an allowance. Suppress the notice, and there you go. Checks come to your house or a PO Box, drop address, etc.
Could you do it without the assistance of a member of the public? Sure. Can you just happen to observe some other employee's PIN? Sure. Could you find a computer left logged on? You betcha. And, many people have done these things and more. Paper files do not assure an absence of fraud. After all, someone has to put two and two together when processing the paper. And, with the current level of pendings and backlogs, this is not always possible. Nancy Ortiz