The Buffalo News has posted the first of a two part article on the delays and difficulties involved in getting approved for Social Security disability benefits. Here's a small excerpt:
... “I do think some legitimate claimants have been hurt by some of the efforts to crack down on fraud, after the Eric Conn case,” said Som Ramrup, president of the American Association of Administrative Law Judges.
Ramrup said she believes the actual amount of fraud in the applications “is infinitesimal.”
“The government acts as though the amount of fraud is much higher,” Ramrup said.
Michael J. Astrue, who headed the SSA under President George W. Bush, told The News he believes “less than 1%” of disability claims are fraudulent. ...
Let's stop over-reacting to the Eric Conn case. It was a weird, one-off scandal. Nothing like it is likely to ever happen again.
There's a difference between fraudulent claims (person wasn't disabled when he or she filed) and disability claims that are being paid incorrectly due to fraud. T2 cases where people return to work and don't report are not uncommon. I don't mean not understanding TWP and EPE and SSA failing to act on work reports. If you include SSI, it's not uncommon at all re living arrangements, income, resources, etc. Some is misunderstanding but a significant part on the part of SSI claimants is concealing of things that affect payment amounts and eligibility.
ReplyDeleteI will admit that fraud is non existent when reps honestly say they never won benefits for someone that they knew was capable of work.
ReplyDeleteFraud seems very rare. On the other hand, no one seems at all concerned about the billions of dollars wasted defending baseless decisions and paying non-disabled claimants whose claims should and would have been denied if there were realistic performance standards coupled with real accountability. Apparently that waste is hunky dory so long as the claims are getting railroaded through the system at a speedy clip.
ReplyDeleteFrom my understanding Fraud is not really involved in intial claims unless perpetrated by BAD employees w/ bogus claims / PE actions / misdirecting payments . Conn was a rare instance,
ReplyDeleteThe Conn case may be a one off, but any claims rep doing a day of RZs will encounter fraud of some variety. . .
ReplyDeleteA one-off scandal that cost the U.S. taxpayer over $800 million!
ReplyDeleteFraud is minimal in ssd, ssi. The time to reduce cdr’s has come and allocate the funds to serve the needy and the public
ReplyDelete1:19
ReplyDeleteNo, it did not cost the taxpayer $800 million. Tally up the number of individuals who were ultimately deemed not disabled after all the dust settled. That's not as interesting as suggesting that none of his clients should have gotten benefits.
12:03 - I have been representing claimants for 30+ years. I can recall maybe 5 clients who I thought were approved when they should not have been (and these were cases that looked strong 18 months prior to the hearing but did not develop they way I expected). It is much more common for a truly disabled claimant to be denied wrongfully than the other way around. The margins are so slim in SSD practice that no attorney with any experience in this area will touch any case that is not legitimate.
ReplyDeleteI don't believe the Conn scenario was a con game where completely healthy people were getting benefits. No evidence has suggested this. What it was was similar to paying off the mob so you can get your trucks unloaded in 1950s New York City. Conn knew that Daugherty would approve almost anything... So he "greased the wheels" to get his clients approved. Did cases get approved that wouldn't have been approved in other offices or by a different ALJ? Yes. Would Daugherty have approved them if another lawyer had represented them. Likely, yes. That's what his approval rates suggest. What really happened was SSA used Conn to get rid of their high payers and put a squeeze on the remaining ALJs, while hiring new ALJs that would deny more cases. All the data supports this conclusion. Lower approval rates despite more and more evidence being produced to support the claims.
ReplyDeleteAfter 40 years, agree with 4:47. While fraud is present, it is very rare. I have had a number of clients that I knew I could not prove were "disabled" (under SSA standards), but would never work again.
ReplyDeleteWhat is worse than the small amount of fraud is all of those claimants who are denied and give up or die, who should have been paid. That is the real disgrace/scandal.
ReplyDeleteThe truth of the matter with the Conn case was and is truly different.
ReplyDeleteOHO management in Kentucky clearly, willfully, and intentionally stuck its head in the sand for years, basically ignoring all kinds of indications that something was wrong. That in turn directly contributed to that particular situation becoming as bad as it was (remember how management was shown to have retaliated against and eventually got rid of the whistleblowers that eventually blew the case open rather than address the issue of possible fraud? At one point, there was an allegation that some members of management were actually colluding with Conn's lawyers against those employees). The fact that nobody "important" got fired over that debacle is an inexcusable travesty of the first order.
I suspect the handling of the Conn case was influenced by that big NYPD police/firefighter fraud case that blew up in the lead-up to Conn (think there were like ~ 100 claimants involved with that one, all high earners with very high SSA benefit amounts resulting in large losses) and a slightly smaller one in Puerto Rico comes to mind that involved like 70-80 people. In both of those cases, you had organized fraud were the claimants clearly were involved in the conspiracy to defraud. When Conn finally exploded into the media, OIG and SSA simply preceded to presumed every claimant in that case was involved and guilty and treated them as such. Time has shown that there was little direct evidence that many, if any, of the Conn claimants were actually aware of or were even involved in the fraud itself (despite what the agency likes to claim to cover up its own malfeasance in this case).
Also, you should take OIG/CDI fraud loss claims with a huge pinch of salt. I don't know how they figure the losses, but in many cases (especially the CDI ones) the totals claimed on valid cases I've referred never come close to what the government claims in their PR releases.
Our office has referred 5-6 legitimate work concealment fraud cases so far this year. Most of them are being formally prosecuted, though one or two are still in initial criminal development stages. Though we are a smaller office, compared to the sheer numbers of claimants we deal with on a month to month basis, that total still represents a tiny percentage of fraud.
Most of the fraud we see is the little stuff, ie. not reporting living arrangement changes, life insurance policies, property ownership, people claiming working spouses aren't in the household who are, or claiming children are in the household who are not. In other words, the kinds of things that poor people have learned they can do to game the system. That type of fraud should be addressed by program adjustments (i.e. elimination of ISM, marriage penalties, etc), not more CDRs.
One type of fraud that seemed more common was EITC. Mothers with kids claiming they are self employed when they weren't to get the big refunds. Not only defrauding IRS but making the person insured for T2. The big give away was when they denied ever working. Running a business is hard and one would likely not forget they had done it last year. It was easy to tell from the net profit if they had one, two or three or more kids just based on the total net income. I never saw so many businesses with zero expenses.
ReplyDeleteIf you aren’t looking for it, it’s impossible to find. The ban on looking at FB/insta/any socials to look for fraud at the hearing level is indefensible
ReplyDeleteSome of the problem with fraud is the scams that lead to fraud. Illegitimate direct deposit changes, human benefit tracking, anomalous claims, mySSA account takeovers, deceased beneficiaries families collecting checks etc. These smaller scale scams and the resulting fraud are pretty common but can be easily avoided by attentive field office employees and proper referrals. If something doesn’t seem right, ask additional questions. We don’t need to be wasting tons of money on needless cdrs or major fraud investigations when the agency can mitigate the fraud that affects most beneficiaries right at the front window.
ReplyDeleteIronic this came out right after the annual National Anti-Fraud training came out. I’m still waiting on my badge for OrgChart from OSLWD for watching all four. Lol
ReplyDeleteSome of these comments are spot on. You can tell who has and who has not worked for the agency.
ReplyDeleteWhen we measure fraud, are we measuring concrete, prosecutable/prosecuted fraud? or are we just measuring any and all fraud? The latter would be much harder to measure because the vast majority of it either doesn't get reported or doesn't get prosecuted due to lack of manpower/cost-benefit on chasing down the suspect.
Initial claims fraud is (probably) quite rare, outside of SSI claimants hiding ISM issues. Post-entitlement fraud? Yeah, we see that daily. Lots of going back to work without reporting wages, direct deposit changes, family scams, mySSA issues, etc. A good, vigilant SSA employee is worth their weight on gold if they are using their senses when answering phones. Identity fraud rarely, if ever, happens in person as any SSA employee worth their salt will ask to see your photo ID before telling you anything.