I had heard that there were allegations of Social Security disability fraud in Puerto Rico. Until recently I was under the impression that this just concerned a small number of claimants. There's now a class action lawsuit that's in the process of being filed against Social Security concerning these cases that tells us that this is huge. Here's an excerpt from the class action complaint (note that this link expires on May 20) that will be filed once a motion to consolidate is granted:
... Starting around 2013, SSA invoked §405(u) to reconsider plaintiffs’ final favorable disability determinations. The impetus was the discovery of a fraud scheme in Puerto Rico involving non-attorney representative Samuel Torres Crespo. Torres Crespo allegedly worked with four doctors—José Hernández González, Wildo Vargas, Rafael Miguez Balseiro, and Erica Rivera Castro (together, the “implicated doctors”)—to submit fraudulent medical evidence in support of some applications for Title II benefits. After a lengthy investigation that started in 2009, the government indicted Torres Crespo and the implicated doctors in 2013. The indictments charged the individuals with making false statements or representations to SSA. Ultimately, Torres Crespo, Hernández González, and Vargas pled guilty to making (or participating in a conspiracy to make) false or misleading statements to SSA. Miguez Balseiro and Rivera Castro each pled guilty to a misdemeanor count of inadequate recordkeeping; their charges for making false statements or representations to SSA were dismissed with prejudice.
After the indictments were filed, SSA initiated redetermination proceedings for nearly 7,000 disability beneficiaries, including plaintiffs, whose files included evidence from Torres Crespo and/or one or more of the implicated doctors.
As a result of these redetermination proceedings, plaintiffs and approximately 1,000-1,500 other beneficiaries in Puerto Rico lost their disability benefits. ...
With respect to members of the Exclusion Class, SSA excluded all medical evidence associated with Torres Crespo or the implicated doctors without permitting the affected
beneficiaries any opportunity to dispute SSA’s allegations that the evidence was tainted by fraud.
With respect to members of the Non-Exclusion Class, SSA initiated the redetermination process based on a preliminary suspicion that evidence submitted by Torres Crespo and/or one of the implicated doctors was fraudulent. Later, however, SSA made a formal finding that there was no reason to believe that fraud was involved in the beneficiaries’ applications. ...Note the allegation that some of the claimants were caught up in this not because fraudulent evidence was submitted in their cases but merely because they had been represented by someone who submitted fraudulent evidence in other cases. Social Security acknowledged that there was no reason to believe there was fraud in the case of these individuals but still redetermined their cases and cut off their benefits. It's a standard of "you were in the neighborhood where a crime was committed so you must be guilty."
Conversely, they should continue with benefits just because of a zip code regardless of the findings of a rede?
ReplyDelete@2:56
ReplyDeleteBenefits should continue, regardless of the claimant's zip code, during a redetermination if the claimant requests continuance of benefits during the CDR. Conversely, benefits should not continue, again regardless of the claimant's zip code, if the claimant does not request continuance of benefits during the CDR.
Why are you bringing up a claimant's zip code?
Cls could use some more due process but "...merely because they had been represented by someone who submitted fraudulent evidence in other cases." is a real whopper/laugher. "Merely," Charles? Really?
ReplyDelete