A press release from the House Social Security Subcommittee:
Today, Social Security Subcommittee Chairman Sam Johnson (R-TX) introduced the Improving the Integrity of Disability Evidence Act of 2015. The bill will ensure that the Social Security Administration (SSA) uses medical evidence only from reputable sources when making a disability determination.
“Hardworking American taxpayers expect that honest information is used when making disability determinations,” Chairman Johnson said. “It’s just common sense to say if you can’t participate in Medicare, Social Security can’t consider your medical evidence. Americans want, need, and deserve a fraud-free disability program.”
According to a 2013 report released by the Senate Committee on Homeland Security and Governmental Affairs, some claimant representatives seek out doctors who will provide medical opinions leading to a disability-benefit award without question. The report gives an example of a lawyer who sought out doctors with licensure problems to provide medical opinions to support benefit claims.
The SSA’s regulations already prohibit the agency from purchasing consultative exams from medical providers whose license has been suspended or revoked because of concerns with professional competence or conduct. However, the SSA does not have any similar restrictions on medical opinions provided by a claimant. In addition, to protect beneficiaries and federal health care programs, the Center for Medicare and Medicaid Services is authorized to bar a provider from receiving payment from federal health care programs due to certain actions. By law, doctors who have been convicted of program-related crimes, abused patients, committed health care fraud, or have a felony related to a controlled substance cannot participate in Medicare.
This legislation would prohibit the SSA from considering medical evidence from doctors who are barred from participating in Medicare or who were assessed a civil monetary penalty for submitting false evidence by the SSA.
A similar provision was included in Chairman Johnson’s Stop Disability Fraud Act of 2014 (H.R. 5260) from the 113th Congress, and in Social Security Subcommittee Ranking Member Xavier Becerra’s recently reintroduced Social Security Fraud and Error Prevention Act of 2015 (H.R. 1419).Let me explain why this seemingly reasonable idea is really bad. First, anyone representing Social Security claimants who seeks out doctors with disciplinary problems to examine their clients and give medical opinions is a fool. The reports will carry little weight. If you've got any sense, it's not worth even thinking about doing. Only one example is cited. Is this enough to justify legislation? Second, and more important, what do you do about the claimant who has the misfortune of having as their treating physician someone who runs into disciplinary problems? The patient isn't the one who has done wrong. They have no way of knowing that their doctor is going to run into disciplinary problems or, for that matter, that they have already run into disciplinary problems. Honestly, do you check on this yourself before seeing a new physician? Going ahead with this proposal would cause some very sick people to be denied even though they're done nothing wrong. A physician who has fraudulently overbilled Medicaid has done something wrong and should be punished but don't punish their innocent patients.
8 comments:
It is rare for us to send one of our Social Security clients to a consultative exam that we select and pay for (occasionally, we'll send someone for an IQ test or psych eval, but that's rare). It's difficult enough to convince an ALJ to adopt our clients' treating doctor's opinions, let alone an exam from a non-treater that we purchased. It would be foolish to then use a doc with disciplinary problems for those rare consultative exams.
However, I don't mind that they keep "nibbling around the edges" in the name of fighting so-called "fraud" in the system if it keeps them from adopting some of the more drastic changes that have been suggested. This regulation, the work comp offset, and even the new evidence submission rules, while flawed and will harm a small subset of claimants, will have no major effect on the major of claimants. If this allows them to proudly say that they are fighting "fraud" in the SSD program, I'm OK with it.
More hubris from Johnson. Ironically what he has done will diminish the availability of Consultative Exam doctors. As a practicing representative that is where I encounter physicians with pending disciplinary problems (and have always reported those and objected to the same). It will create more work for those who are applying for disability and those representing them, which is fine with Johnson and likely part of the motivation. So the bill makes choosing a doctor or keeping a doctor when you are disabled or alleging disability harder.
There are state and national entities who post physician statistics, most representatives will search these, but Charles is right – it puts an undue burden on those who are alleging disability. Medicare and or Medicaid fraud is not the only reason a physician may be sanctioned. There are no bill specifics listed on is site, so does Johnson suggest that a physician who had a problem 10 years ago, served his charge would never be a viable source? Also many cases involving well-meaning doctors, such as those who treat patients with pain, who will suffer temporary sanctions due to draconian oversight. The majority of legislation Johnson has introduced is based on half-baked methodology and conclusions and designed to prevent the majority of disabled access health care and the programs they are legitimately eligible for. What a waste of time and money.
In our area, I've had at least three client's see one primary care physician who had to surrender his license because he was allegedly inappropriate with female patients. (I'm saying this tactfully. I think he was a scumbag). Seems a heck of a stretch to say that his records should not be considered, or given less weight because of a non-fraud related issue.
Justin
Who is going to know? Patients are unlikely to know their doctors' disciplinary history unless the doctor has really screwed up and there have been media reports. ALJS/ODAR staff are not going to take the time to check the disciplinary record of every treating or examining source who provides care to the thousands of claimants whose case come from the ODAR office each year.
The only medical providers likely to really be affected or known are individuals like the two idiots Eric Conn paid for fraudulent MSSs, and SSA has already sanctioned them and declared their submissions inadmissible.
Sigh. Johnson picking on the poor again. It's almost like they are treating the poor and people with disabilities like pinatas. Put a blindfold on, and take another swing, and hope you knock some government benefits out of the safety net programs.
I also never send clients to physicians for evaluations to be used for benefit claim purposes. I have, on numerous occasions suggested to clients that they get particular medical help, most often psychiatric care or specific testing, neuropsychological testing most often, because I believed they needed that care or I thought that testing would be of some medical, as well as, legal use. I have even given names of providers, when asked, but I have always made it clear that who they saw was up to them and that the prime reason to see them was therapeutic, not legal.
I do not see, however, sending someone to a physician to obtain an honest report, as is done in personal injury cases or Workers Comp case or as done by the SSA in SS disability cases as being at all improper. It goes to the weight of the resulting report but not its relevance.
I have also had clients who were seeing doctors who subsequently were defrocked, mostly for improper prescribing of narcotic drugs. I sometimes learn of this from the news or from other clients. The mere fact that someone lost their license in this way may affect the credibility of their reports, particularly where pain is an issue, but that is no reason to exclude their reports entirely.
As with other of Johnson's claims, there is a lot of anecdote and exaggeration signifying little or nothing of consequence.
I have had several cases come before me recently where the doctor had lost his license. When the attorney volunteered this information, he went up in my book. When the attorney admitted he deliberated tried to conceal that information from me, his integrity was called into question. Yes, argue that the opinions are still valid--but don't try to hide this from the judge.
When drafting legislation, it would be wise to consider all possibilities (incredibly difficult for a posturing politician). While I was on the faculty of a medical school basic science department, a study reported that 20% of all physicians would abuse or become dependent upon drugs at sometime during their practicing career. To combat this, various programs have been developed to help dependent physicians seek rehabilitation. So, the time-related question asked by 9:41 is very relevant.
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