From a report by Social Security's Office of Inspector General:
On December 12, 2014, we received a request from the Chairman of the Subcommittee on Social Security, Committee on Ways and Means, to provide information on how SSA ensures beneficiaries follow prescribed treatment. ...
We identified 15 instances where SSA [Social Security Administration] denied benefits — or removed a beneficiary from the disability rolls based on a CDR [Continuing Disability Reviews]— for failing to follow prescribed treatment. Of the more than 2 million disability denials in 2012, only 5 were denied because the individuals failed to follow prescribed treatment. Of the 122,000 initial CDR cessations in 2012, the Agency ceased 10 because the individuals failed to follow prescribed treatment. ...
Additionally, w e reviewed a sample of 200 initial claims allowed in 2012 and found 23 had a possible failure to follow prescribed treatment issue. In 22 of these 23 claims, the adjudicator processed the claim in accordance with SSA policy. However, in one claim, the adjudicator did not follow Agency policy since he/she did not develop a potential failure to follow prescribed treatment issue.
We also reviewed a sample of 200 CDRs continued in 2012 and found 11 had a possible failure to follow prescribed treatment issue. In all 11 claims, SSA handled the issue in accordance with policy. ...Perhaps the interesting thing here is the request from the Chairman of the House Social Security Subcommittee. It seems to be part of a Republican search for Social Security disability villains. It is similar to the recent suggestion by one Republican officeholder that mothers were intentionally poisoning their children with lead in order to get free housing. Sorry, guys but you're not going to find claimants refusing medical treatment so they can be found disabled or remain disabled. That's virtually nonexistent. And, no, Social Security's failure to find instances of this happening doesn't mean that Social Security hasn't been looking for it. It's because it just about never happens.
12 comments:
So, someone is going to purposely make oneself sicker by failing to follow prescribed treatment for the privilege of waiting 2+ years to see a Judge and have a 40% chance of obtaining a benefit that still places one below poverty level? There's plenty of reasons to hold CDRs, but this isn't one of them.
"Of the more than 2 million disability denials in 2012, only 5 were denied because the individuals failed to follow prescribed treatment."
That's such a farce. I see cases weekly where SSA finds the claimant not credible due to failure to follow prescribed treatment and thereby denies the claim even though SSA never followed the formal requirements for a finding of failure to follow prescribed treatment. SSA knows that the burden for establishing failure under the regulations is typically to high for them to meet so they just do an end around.
Giving a choice between the rich and SSDI,SSI beneficiaries republicans will always attack beneficiares.
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There are several reasons that my clients in Western North Carolina may not be in compliance with treatment:
(1)it's now common for ALJs to specify a CDR in 1 year or 18 months. I'm not sure when the clock starts running, but the other day, an ALJ verbally announced he'd award benefits. However,it will probably take 2-3 months before we receive the written decision. Then the beneficiary will have to take the judgment to the Department of Social Services (DSS)to apply for Medicaid; the County will drag its feet in processing the request, so it may be a few more months before the beneficiary receives his Medicaid card.
(2) We live in a semi-rural area with no generally available public transportation. Unless they are still married to a job-holding spouse in this high unemployment area, many of my clients have lost their vehicles and have great difficulty traveling to treatment by specialists which often requires a trip of 25 to 50 miles. DSS hasn't helped either--a few clients have informed me that the primary care physician to which they've been assigned (and is willing to accept Medicaid patients) has been several counties (perhaps about 100 miles) away. It strikes me that the assignment may have been made to make it impossible for these indigent beneficiaries to obtain treatment and to spend Medicaid's precious assets (See next point).
(3) I have always represented my clients pro bono in Medicaid hearings to help them obtain medical treatment to provide evidence in their SSDI/SSI claims. My win rate used to be 75%, but one current Medicaid Hearing Officer (she used to be a DDS supervisor) only approved 8% of the cases which were brought before her. We are now seeing that Medicaid will not approve many medications, operations, or other medical treatments that treating sources prescribe for patients. Our state is also one in which extended Medicaid has been refused. Even if my clients wish to comply with prescribed treatment, they cannot afford it, and Medicaid is refusing to allow treatment access.
Isn't our American healthcare delivery system wonderful? I've been fighting bureaucrats in Social Security/Medicaid for over 26 years, and it's made me cranky. That's why I frequently sign comments as
--the Social Security curmudgeon
What I am sure is lost on asshat Republican members of Congress, but the OIG report makes clear is that, under the regulatory definition of the term "failure to follow prescribed treatment," a denial for such should be extremely rare. What is not rare is that decision makers make negative credibility inferences based upon failure to follow prescribed treatment. That is a different matter, however.
I see a small number of ALJs, a minority, who use their own little formula for failure, mention it, fold it into lack of credibility and deny. Examiners know better and can't get away with it anyway.
We can think the Appeals Council for ignoring this and other time-consuming things like reviewing ALJ denials because they cannot find the material and harmful errors.
Even so, the study was a worthless political endeavor resulting in a waste of taxpayers funds to as C. says, hunt for villains.
As pointed out in the report, in most cases in which people who are denied are not following treatment, the Listing itself requires that the condition persist at a given severity despite treatment. Thus if someone is not following treatment, the Listing is not met. There is no issue of subterfuge by making it an issue of credibility.. As the Listing is not met failure to follow does not arise either. A typical example might be where a parent uses the ER as the primary treating source for a child's asthma even though they have been told to take the child to the free or low cost or accepts child's Medicaid childhood asthma clinic associated with the same hospital. That said, most people care for their children and provide them with the best care they can.
To 11:07 AM. In addition to your comments there are claimants who were successfully receiving treatment at a Free Clinic. However once they received SSI and were eligible for Medicaid the free clinic could no longer see them. Some of the same doctors who work for free at the Free Clinic did not accept Medicaid. Similarly some people who were receiving care with Medicaid due to SSI eligibility lost it once their DIB benefits kicked in. Then they had to deal with the two year waiting period before being eligible for Medicare.
I am seeing more and more ALJ decisions that fail to consider well-documented reasons why indigent and mentally ill claimants are struggling with accessing the medical care their physicians want for them. A vast majority of those occur in the credibility analysis.
Recent example: Agoraphobic mentally ill claimant with no income, no reliable transportation misses about a third of her appointments due to her mental illness and circumstances. Documented not only in her testimony but also the medical records. Cannot reliably follow instructions, impaired memory, impaired concentration. Found not credible because of the missed appointments and sometimes forgetting to take her medication correctly.
Social Security Rulings address these situations, but I am seeing more than a few denials like this anyway, with specific reference to the credibility issue. It smacks of punishing or discriminating against the claimants because of their disabilities, which seems very wrong in a program with a purpose of helping people with disabilities.
The fact that someone is poor and has difficulty getting medical treatment should not matter. We are all equal under the law:
"The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread."
--Anatole France (16 April 1844 – 12 October 1924)
"The individual may be unable to afford treatment and may not have access to free or low-cost medical services." - required considerations in evaluating credibility, SSR 96-7P. As much as I like the quote, sorry Anatole. Although I would like to see some rich folks sleep under a bridge, beg in the streets, and shoplift some bread!
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