Nov 17, 2014

OIG Report On ALJs With High Allowance And Disposition Rates

     The Office of Inspector General (OIG) report on "outlier" Administrative Law Judges (ALJs) who have unusually high rates of approving disability claims and who also dispose of many cases is out.
     I have to repeat what I said in response to the press reports that this was coming: 
  • Where did OIG find the gold standard for determining who is and who isn't disabled?
  • Will OIG share this gold standard with the rest of Social Security? The agency has been seeking this gold standard for more than 50 years. 
     The OIG report gives essentially no information about the gold standard they found. It's not clear who administered this gold standard. What sort of training and experience did those people have?
     Of course, I and others keep wondering when OIG will take a look at ALJs with low allowance rates.


Anonymous said...

the "gold standard" is codified in the Social Security Act and the CFR. It's not applied even remotely accurately by the majority of ALJs. Including those at the high and low end of those who deny/grant claims.

Anonymous said...

Upon reading the report, which says the review was done by qualify reviewers, it seems the review was done by folks at AC.

Anonymous said...

It would be interesting to know what percentage of the 275 cases reviewed were made by former Huntington WV Judge David Daugherty, who from all published reports feel into the Outlier definition, or involved Attorney Eric Conn. If they removed those cases from consideration (based on a presumption of potential fraud/corruption being involved), what does that do to their statistics?

Anonymous said...

Anonymous Anonymous said...
This is a whack job done for Isa. No specific errors identified. The report mentions deficient medical vocation decisions, onset errors and one very vague example of a deficient case -

QUOTE For example, one ALJ’s decision related to a 50-year-old claimant who applied for benefits in June 2010 alleging back problems and affective/mood disorder. The State disability determination services examiner denied the claim determining the claimant could perform past work in the national economy, and the decision was upheld at the reconsideration stage in March 2011. In August 2012, the ALJ issued a favorable decision citing that no jobs existed in the national economy that the claimant could perform. In our review of the ALJ’s decision, we found the ALJ did not provide sufficient rationale for the decision. END QUOTE

Over two years since the DDS decision (given that was accurate) the OIG and DQ “reviewers” - 4 program analysts, the rest auditors, a director and one intern) scientifically determined the ALJ did not provide sufficient rationale (never defined) for the decision. Well, there is specific proof for you. The whole report is a waste of time and taxpayers’ money. The OIG should be ashamed. This is the junk science and provides no basis for extrapolating this 275 “case review” results in “questionable” costs of “approximately” $2 billion

Anonymous said...

It's far, far worse when a person who should be entitled to benefits gets improperly denied, than when one with a questionable claim gets approved. The purpose of the whole system, to provide assistance to those meeting the program criteria, is thwarted.

The fact is that some ALJs turn down legitimate, documented claims in droves. They are sitting there like bad apples in a barrel, easy to find, with documented low approval and high remand rates. There are many well considered Federal Court decisions, spelling out in detail how the ALJs are wrongly denying the claims. Some of them are egregious.

The fact that OIG is putting on a blindfold, covering its ears, and zipping its mouth regarding the high denial outliers is speaking volumes, and here's what I am hearing: We bow to political pressure. We prefer to investigate things that can justify us asking for a bigger budget. We don't care about investigating problems that result in alot of people with legitimate disabilities getting denied. We'd much rather do things that get more people cut off of benefits so we can show how much money we are saving.

How sad.

Anonymous said...

Agreed, @5:12. DQ is made up of mostly attorneys at this point (same as the AC, slightly less so with DWs at the HO), so they do at least mostly have legal training.

Obviously, Congress/the public only cares when people are paid erroneously because this is seen as waste (we could argue about the money spent continuously readjuducating inappropriate denials at higher levels of appeal caused by compounding errors).

However, what they are looking at here is legal sufficiency, which is a different metric than "factually-correct outcome." The vast majority of ALL ALJ decisions (favorable or otherwise) contain significant error in some way, most of which is probably at least remandable if you are a stickler for following the regs without doing a "is the outcome correct?" calculus.

I think one of the biggest problems is probably that DWs are given much less case credit/production time to write a favorable decision than an unfavorable (I think it's 4 hours). These metrics are of course always independent of the size of the file or the complexity of the case. Consequently, the decisions seem to invariably just give an RFC for excessive absences/breaks to get to a Step 5 favorable because it is easy to write vs. actually looking at the record and determining, for example, X date is the date the claimant started needing a walker which either meets/equals a listing for inability to ambulate effectively or is a work-preclusive RFC restriction in standing/walking/carrying under SSR 96-9p. Even when the evidence actually supports an RFC with excessive absences/breaks (many hospitalizations in a calendar year, frequent debilitating migraines, C-criteria-level vegetative symptoms in mental impairments, etc.), this RFC is rarely seen. When it is inappropriate, it is pretty clear by the lack of rationale pointing to anything in the record upon which you could infer the likelihood of frequent absences. I have a feeling this is exactly the type of "lack of supporting rationale" OIG is referring to in the report.

We could probably fix a lot of this error by just hiring actual doctors who get good training and are paid decently to make all the determinations in their specialty instead of relying on disability examiners, and doing forensic psychological CEs and actual vocational rehabilitation-type functional capacity evaluations (by partnering with those agencies) to determine more accurate RFCs.

Anonymous said...

Agree with most of what was said above [8:57] except the solution- SSA doctors do receive good training and are paid decently. It is cost prohibitive for SAMCs to make all the determinations in their specialty and they don’t rely on examiners. The CE quality is likewise about the best SSA will pay and that is not enough for forensic psychologicals or functional capacity evaluations. Collaborating with VRs has never worked in my opinion for many reasons.

Anonymous said...

I wonder if OIG would conduct an investigation of low paying outlier ALJs if a claimant friendly Senator such as Warren or Sanders asked them to. I'm asking because I legitimately don't know--does OIG have to conduct an investigation if asked to do so by a member of Congress?

Anonymous said...

In response to the comment about unnecessary costs in adjudicating denials that should have been awarded the OIG can use as a sample my client who is schizophrenic and has a forensic case worker because he was released a couple years ago from a state hospital as he was adjudicated not guilty by reason of insanity of a murder he committed while on a break from reality. DDS did a knock up job on that one.

Anonymous said...

Great point about the report on low granters that will never come.

So 4% of ALJs are high granters. I wonder how many are low granters. I am sure more.