Under sections 205(u) and 1631(e)(7) of the Social Security Act (Act), the Social Security Administration (SSA) must immediately redetermine the entitlement of individuals to monthly disability benefits if there is reason to believe that fraud or similar fault was involved in the individual's application for such benefits. A redetermination is a re-adjudication of the individual's application for benefits, based on the agency's finding that fraud or similar fault was involved in an individual's application for monthly disability benefits. The agency may be required to initiate a redetermination based on an Office of the Inspector General (OIG) referral of information pursuant to section 1129(l) of the Act or information from a criminal prosecutor with jurisdiction over potential or actual related criminal cases. ...
The Deputy Commissioner of ODAR will determine which ODAR component is designated to redetermine the affected case(s). ...
Based on OIG [Office of Inspector General] referrals of information pursuant to section 1129(l) of the Act or information obtained through other criminal, congressional, or administrative investigation, the agency may direct an ODAR adjudicator to disregard certain evidence.
There are a couple of problems here. Administrative Law Judges are required to be assigned to hear cases in rotation insofar as practical. If Social Security gets to decide which "component" gets to hear a case isn't Social Security getting to decide which ALJ hears the case? Social Security could assign the case to the Anchorage hearing office with its 14% reversal rate for instance. If the agency wants to set up some special cadre of judges selected using some neutral criteria to hear these cases that's one thing but that's not what they're talking about. Second, Social Security gets to decide which evidence the ALJ can and can't hear? Are you kidding me? Did anyone at Social Security give serious consideration to how this might look to a federal court?
3 comments:
Since 1985 I have been investigated twice for possible fraud based on erroneous action by new Social Security staff. I knew I was supposed to still get needed benefits while being investigated. But, I couldn't convinced Social Security of that. I did finally get a bit back to catch me up on help lost for no reason -- $200! I was cleared both times. However, the time I was without medical insurance or income worsened my disability. I believe I will die sooner as a result. So yes, continued support while being investigated is very important.
I'm not sure that office shopping would be especially effective. I've worked in multiple ODAR offices and a large amount of the variance can be explained by different claimant demographics. An office with a higher than average number of child's cases is likely going to have a higher than average denial rate. Offices in areas with a lot of blue collar jobs lost to the economy will likely have a high approval rate as they will have a higher than average number of over 50 and over 55 workers without skills transferrable to sedentary or light.
Now if they pick the judge, they can certainly pick and individual ALJ to give a high probability of a desired result.
Agreed, 11:26! It now appears that at the ODAR where 95% of my cases are heard, which ALJ is assigned to a case is much, much more determinative of the outcome of the case than is the medical evidence within the record. There is no longer AHY consistency within the system--except for the 15% approval ALJ's.
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