From the Dallas Morning News:
I wonder if there was gilding of the lily going on here -- people who had genuinely severe mental impairments who added an overlay of phoniness on top of real mental illness. That seems more likely to me than completely factitious disorders.
The key thing is that you don't get on Social Security disability merely by showing up for one consultative examination and acting like you think a crazy person would act. If you're not involved with the program, you may think it's that easy but it's not.
Some Arlington family members who got a free ride from the government for years by faking mental disabilities have admitted to committing an extensive ruse.
Doreen Mitchell, 54, and her cousin, John Mitchell, 60, as well as her two sons, Michael Mitchell, 31, and Sonny Mitchell, 28, have agreed to plead guilty to the scheme in federal court in Dallas, court records show.
The family members helped one another fake mental disabilities for years to collect more than $460,000 in benefits from the government, prosecutors said. They were arrested in 2015 after suspicious agents secretly followed them to expose their well-rehearsed hoax against the Social Security Administration.
The agents found them dressed normally and engaging in routine daily activities such as driving, shopping and socializing in large groups, court records said.
But all four “misrepresented their actual levels of intelligence and functioning” during interviews and examinations with Social Security employees, authorities said, including claims that some of them talked with ghosts. ...
Doreen Mitchell first applied for disability benefits in 1979 when she was 15 years old, “alleging visual and auditory hallucinations,” court records said. She claimed she suffered from schizophrenia and other conditions.
She once attended an SSA exam wearing a dirty nightgown and “mumbled unintelligibly to herself,” according to court records. She told investigators that she could not read or write. ...
Federal investigators suspected Doreen Mitchell was faking mental illness in 2004, and her benefits were stopped. She appealed that decision in 2005.
At the hearing, she appeared to talk with her dead father. But the hearing officer noted that “her auditory hallucinations ... appeared to be an act,” and her appeal was denied. ...I don't know anything about the evidence here. I do know that it's virtually impossible to get a Social Security disability claim approved on psychiatric grounds for someone who isn't in psychiatric treatment at least off and on. I say off and on because some of the most severely impaired individuals can't manage to stay in regular treatment. That's one of the signs of how severe their impairment is. However those folks also tend to end up in psychiatric hospitals on involuntary commitments. Faking impairment for one consultative examination is one thing. Faking it for visit after visit to a mental health provider is another. Getting yourself hospitalized for phony psychiatric problems is nearly inconceivable. It's hard to imagine many people trying to do any of this much less successfully pulling it off.
I wonder if there was gilding of the lily going on here -- people who had genuinely severe mental impairments who added an overlay of phoniness on top of real mental illness. That seems more likely to me than completely factitious disorders.
The key thing is that you don't get on Social Security disability merely by showing up for one consultative examination and acting like you think a crazy person would act. If you're not involved with the program, you may think it's that easy but it's not.
I have seen more than one person figuratively shoot their foot off. May be functioning around 5th-7th grade level or so with some real problems. They go to their exam and dogs have five legs, they can't count to ten, there are 10 months in a year, 20 days in a month, and can't name who the president is but asked to list four famous people it's Mickey and Minnie Mouse, Bugs Bunny, and Fred Flintstone.
ReplyDelete"The key thing is that you don't get on Social Security disability merely be showing up for one consultative examination and acting like you think a crazy person would act. If you're not involved with the program, you may think it's that easy but it's not."
ReplyDeleteReally? Ask any rep that practiced in that area from about 2004-2010, and they can tell you about a judge that awarded benefits based on the MMPI. Any rep whose client was going before that judge would quickly get them to a doctor to have the MMPI run, and over 90% of the claimants that came before that judge were awarded benefits during that period of time. The only way they weren't is if they were unrepped and failed to show or refused to play the game and get the MMPI done.
And while I agree that a CE shouldn't be enough to award or deny benefits, reps never fail to come into the hearing room and say, "Judge, based on Dr. X's CE report that says the claimant has marked limitations in social function and CCP, he'd meet a listing or at least be incapable of sustaining work activity, and he's your doctor." I often wonder how many times DDS awards benefits on the basis of these CEs as I've seen plenty of times when they have after the claimant appeals a later onset date that is based solely on a psych CE without any evidence of other MH treatment.
I would agree that a scheme this elaborate is probably rare. However, the exaggeration of symptoms to try and get the "crazy check" are more common than you want to believe.
ReplyDeletePeople try to get a crazy check all the time. It just doesn't work the way they think it will. The most lenient judges get turned off by faked CE's in my experience. When my clients fail to remember when Christmas comes, I won't even do the case.
ReplyDeleteSo you say it's "virtually impossible to get a Social Security disability claim approved on psychiatric grounds" in your post, yet your post documents a court decision about four people fraudulently succeeding in such a scheme to collect over $460,000. We should also add in the costs of handling all their claims, appeals, post-eligibility work, bills paid by medicare and medicaid, and pursuing this court case and efforts to recoup these funds in that total. That might easily double the loss. It is not as "impossible" as you think. Peel back this onion and I am sure these are not the only people to succeed in doing the virtually impossible.
ReplyDeleteThis case went to court, but how many are not prosecuted for a variety of administrative reasons? Cases like this might make it harder for some who are disabled to get benefits, but just because something is harder does not mean that it is unfair. We have a responsibility to protect the trust funds for those eligible based on evidence, not actions designed to game the system.
A question remains - to what extent was their lawyer aware of their clients true state? Were legal consultations and meetings characterized by similar behavior episodes or were they more rational when dealing with their lawyer so they would be awarded benefits and the lawyer collect a fee? Please consider everyone who has skin in the game. Better call Saul!
Even if the person got away with getting awarded benefits with a faked CE, how did they stay on through numerous reviews? And if Doreen was approved when she was 15, what kind of life did she have subsisting on SSI of $735 a month? A doctor or a clinic had to be complicit in this if she was able to perpetuate the fraud this long. I represented a client when I was with Legal Services (so no fee) who peed on the doctor's floor, drooled throughout her hearing, and ignored my pleas to just be herself. She was disabled in my opinion but overdid her limitations so badly when it counted, she couldn't get a good medical report or favorable hearing decision. Obviously, it happened, but I don't see how this got past so many SSA offices, CE's, and state disability determination services. I don't see this happening in Mississippi.
ReplyDeleteAlso, when this started, there was no withholding of fees for SSI.
When this started, there
I think you're right about the extent of the fraud. As an attorney advisor/decision writer, I spend more time with the case than anyone else in the process, including in most cases, the rep. I see loads of cases where claimant present with all kinds of complaints and symptoms, but they are denied. Either because we find conflicting evidence, like function reports and inconsistent statements to treatment providers, or sometimes because they are just not compliant. Very often, claimant's show up for a few months, get much better, and then drift off into noncompliance or back into DAA. However, as you alluded to, its really not easy to get disability. Even a claimant with significant mental issues is not necessarily disabled. The mental impairments and symptoms may diminish their RFC, but the VE's always find unskilled work with minimal social contact. I think the area it affects the most in terms of the six-step process, is PRW. Very often, the judge will limit them to US or SS skilled, and that prevents them from PRW, assuming the exertional limitations are not to restricting.
ReplyDeletePersonally, if the agency wants to prevent fraud, they need to get out there an investigate. In over 500 cases I have worked, I have only seen one case where the State agency actually sent out an investigator and found some pretty damning evidence. And it doesn't mean that the Agency has to send out a million investigators to go after every claimant. First, listing cases are usually pretty solid. The same is true for most grid rule cases over age 55. If a judge finds someone at Sed or light at age 55 without PRW, there is little chance that they will improve or that they can really do medium work. It can be done very efficiently.
The agency can use their big data capabilities to flag cases with a high probability of fraud. Also, ALJ's for the most part have a lot of intuition. That's why we hire them! In many cases, I think the ALJ really struggles with finding the claimant disabled, but there is just not enough in the records to dispute their claims. Or vice versa, there is just enough in the records to support their claims. ALJ's should be able to issue a decision, and then flag the case for follow up by an investigator. That will allow the judges to act on their hunches without turning them into agents who have to dispute the claimant's credibility.
Once the agency identifies these cases, they can organize them by region, and then narrow it down to a specific city or neighborhood. They don't have to send investigators to every claimant. They could just assign one person to a city or neighborhood. That investigator can look at several claimant's who all live in the same area. He can observe them covertly and take detailed notes, using functionally relevant terminology, describing their daily activity. Then, an ALJ, or whoever deals with fraud redeterminations, can compare those notes and their functional significance with the claimant allegations.
@1:07
ReplyDeleteI'm not certain they were seen by a CE. The articles language is unclear, and seems to suggest the family members misrepresented their intelligence and functioning to SSA employees and CE's...technically, are not employees of SSA. Also, family members are not usually seen by CEs, so that also suggests the behavior was in front of SSA employees, not CEs.
Even still, if a CE is aware of the prior determinations it would not surprise me to learn they just rubber stamped the prior findings.
@2:42
ReplyDeleteI've never understood how there can be conflicting evidence in regard to a claimant's function reports due to the sheer vagueness of most reports. For example, a claimant stating they have difficulty walking is not inconsistent with a doctor saying they can only walk 6 out of 8 hours, or even the claimant elsewhere stating they went for a walk, as the function report's statement did not quantify their ability to walk.
In regard to your comments that the ALJ might have difficulty in denying or awarding a claim because the records are not sufficient to support a claimant's claim of disability, that's pretty simple. The claim is denied due to insufficient evidence. If there is "just enough evidence in the record" to support their claims, the claim is awarded. Neither insufficient nor limited evidence is suggestive of fraud.
In regard to your suggestion that allowing ALJs to act on their "hunches" without making them into agents who have to dispute a claimant's credibility...honestly, I'm not certain what you mean. An ALJ acting on their "hunches" should be horrifying to both representatives and the Administration alike.
As a long time rep I have only reviewed about a half dozen claims where investigators were sent out to view my clients and issued reports that were in the record. In one of those I agreed that the investigator found evidence of wrongdoing by the claimant which I was unaware of before. I promptly advised withdrawal of the claim. But in the others, the quality of the investigation was almost comically poor. Examples included incredible logical leaps by the investigator, findings of wrongdoing based on guesswork about the meaning of claimant facial expressions, and generalizing about the claimant's long term function based on viewing them for about 10 minutes. In each of those they appeared to be straining to find something wrong in claims where it was unwarranted.
ReplyDeleteArmy full bird, also clergy, retired. Filed disability upon retirement for PTSD from LISTENING to the stories of the troops. Awarded full retirement, VA DIB and SSA DIB. As a vet, my stomach turned. Left the firm that was doing these cases and haven't looked back.
ReplyDeleteAnyone who stayed on as long as these folks should have seen several different CE's. Social Security folks don't make the determination.
ReplyDeleteIn my 40+ years of disability representation, two of my clients have had the fraud unit sent out. The one sent out by the DDS sort did an investigation that sort of amounted to watching the person from behind the bushes. The other one was more professional. In both of my cases, the medical records weren't as strong as I would have liked, but the claimants were disabled. They overdid their limitations too much in front of a CE and a law judge. They were denied. One of them was close to early retirement, so she was able to get some limited income shortly after she lost her hearing.
RE CDRs--sometimes it is way more years than the case is diaried for before a CDR actually gets done. I have seen several 10-15 years or more for a 3 year diary. Also have had folks come in wanting to get a letter saying they have a 7 year diary (in regards to repaying student loans) where we haven't done a CDR in ages. Every 3-4 years a questionnaire is sent to the claimant and upon return the case is rediaried for 3 more years. So I can see how it could be a very long time in some cases.
ReplyDeleteRe OIG fraud investigations--the few I have seen usually involve two agents showing up and talking to the disabled person for maybe a half hour or so under some kind of ruse. I don't know what the ruse is but I'd guess something along the line of someone was using or working under the disabled person's SSN. Sometimes the investigators will interview neighbors for their take on the person and how they are moving about, acting, etc.
I'd guess from very limited review of such cases that most of the folks probably do have some disability although it may not be severe enough to be on Social Security. I'd also say that the folks in these cases (accused of malingering by DDS) overstate their limitations. They can't read or go out on their own but have a driver's license ad car registered in their name. I can't say that I have ever seen an OIG referral for malingering where the person was not portrayed as not genuinely truthful by OIG. And I agree with someone above about making statements about a disabled person's mental status based on talking to them 30 minutes by agents seems at times to be a real stretch on the part of OIG.