From a recent report by Social Security's Office of Inspector General (OIG):
Statutory benefit continuation allows an individual to continue receiving disability benefits during the appeal of a medical cessation determination at the reconsideration or ALJ hearing levels. If the cessation determination is upheld after appeal, the Social Security Administration (SSA) considers the payments received during the appeals process overpayments the individual must return to SSA. ...
We project SSA overpaid approximately $682.5 million to individuals in our population who continued receiving disability benefits during the appeals process but for whom ALJs upheld the cessation determinations from October 1, 2013 through July 8, 2016. This comprised $138.5 million overpaid to DI beneficiaries and $ 544 million overpaid to SSI recipients.
We estimate, as of August 2016, SSA was in the process of collecting 28 percent of the amount overpaid to DI beneficiaries. It had collected only 4 percent, waived or terminated collection action on 17 percent, and posted another 37 per cent to the beneficiaries’ records but did not take action to collect, waive, or deem them uncollectible. SSA had not posted about 14 percent to the beneficiaries’ records for collection. Likewise, for the amount overpaid to the SSI recipients, SSA was in the process of collecting 61 percent. It had collected 2 percent, waived or terminated collection action on 13 percent, and had posted another 17 percent to the recipients’ records but did not take action to collect, waive, or deem them uncollectible. SSA had not posted 7 percent to the individuals’ records for collection. The average processing time for medical cessation appeals had increased from our prior reviews. Specifically, processing times were 766 days for sampled DI beneficiaries and 831 days for sampled SSI recipients — increases of 18 percent and 20 percent, respectively. If SSA prioritizes medical cessation appeals, it could increase DI and SSI programs’ financial performance. For example, we project SSA could have avoided $69.7 million in DI overpayments and $266 million in SSI overpayments had it completed the appeals process for medical cessation s within its processing time goals totaling 394 days. ...The agency's response to the suggestion that it should prioritize cutting people off benefits because that would save money was to say "We agree."
8 comments:
I haven't read the report. Is there any mention of how many millions of dollars was paid to individuals who went on to succeed in having their benefits continued? That's the more important number.
The vast majority of CDRs result in continuation. See Chart 2 at http://www.ssab.gov/Details-Page/ArticleID/1105/Disability-Chartbook-Chapter-3-Continuing-Disability-Reviews
The difficult thing with CDRs is that representation is difficult to obtain. Most of us can't afford to do very many. Legal Services does some cessations but they're so strapped for funds, they're not doing very many.
The biggest time suck in CDR processing appears to be with the wait to have a hearing with a hearing officer at the recon level. But with over 70% of recon determinations resulting in a continuance of benefits, it seems ludicrous to stop continuation of benefits at that level while the appeal is processed. ODAR has been giving priority processing to cessation cases where there is benefit continuation, typically scheduling those cases within a few months. Look like they need to focus on getting things moving more quickly at recon if they want to appreciate any significant savings.
The article says "If SSA prioritizes medical cessation appeals, it could increase DI and SSI programs’ financial performance. "
If a person's sole source of income is SSA disability payments and those are cut off, how are they going to re-pay the over-payments? Where is that money going to come from? Geniuses.
Cessation often occurs because claimants do not understand their need to respond to CDR review inquiries. SSA does a terrible job of reaching people, especially mentally ill claimants, who do not respond to initial inquiries.
The use of hearing officers at the recon level is a complete waste of time and money. In almost 30 years of practice, I have NEVER ONCE won a child's SSI case or a CDR case before a hearing officer, often despite tendering a brief with completely new evidence. For most of those years, one particular officer was the only one who ever heard cases from this area. A few years ago, two other officers rotated into cases, but the result was the same--and this was often cases in which ALJs reviewed the cases and conducted a cursory hearing and continued the benefits. One year at NOSSCR, a hearing officer presented a session, and she thought she was so very generous in granting 20% of her cases--at a time when ALJs rates were much higher.
Read SI 02200.007:
https://secure.ssa.gov/poms.nsf/lnx/0502260007
The good faith provision is almost universally ignored at the FO level when they're developing waivers. The provision is there to remove the gambling element; if you make all your appointments and didn't try to hide income/support, then we're supposed to consider you without fault for the continuation overpayment.
Post a Comment