Social Worker Case Manager Job Advertised

Social Security has now advertised five job openings for "Social Worker (Case Manager)." This is part of the Disability Service Improvement (DSI) experiment. The job appears to be nearly identical to the Nurse Case Manager positions advertised earlier, only the job applicants do not have to be nurses. However, a masters degree in social work is required. One might guess that Social Security had trouble finding enough nurses to fill the positions. Below is the job description:

Provides psychiatric/medical policy, procedural, and technical advice and guidance to DDSs, ROs, ALJs, the DRB, OQP and the national network of experts affiliated with the OMVE on complex issues encountered in making the determination or decision in a disability claim. This technical advice and guidance includes confirming what medical, psychological and vocational expertise is needed as well as verifying the need for additional medical or lay evidence, tests, or a consultative examination. Verifies that the request is in accordance with disability law, regulations, and policy.

Provides expert psychiatric/medical advice and guidance to the DDSs, ROs, ALJs, DRB, OQP and the national network of medical and vocational experts.

Ensures that the disability adjudicators in the DDSs and ROs and the ALJs have requested expertise or development that is needed and appropriate.

Ensures consistency in medical disability determinations by the DDSs, ROs and/or ALJs in accordance with established regulations and national practices.

Determines if beneficiary contact, current psychiatric/medical evidence and/or consultative examinations are required; assists DDSs, ROs, ALJs, DRB and OQP in obtaining appropriate evidence and examinations; and, as necessary, contacts sources (Medical Consultants, national network of experts, etc.) for assistance in interpreting medical evidence and/or determining whether additional evidence is required

Monthly Statistical Packages Released

Social Security has issued its monthly package of statistics on Title II and Title XVI (SSI) of the Social Security Act.

Emergency Message On Attorney Registration

Social Security has issued an Emergency Message to its staff on the upcoming requirement that attorneys representing Social Security claimants register with Social Security and provide their Social Security number and direct deposit information. The Emergency Message indicates that training for Social Security staff starts on November 8, 2006. Because of budget problems, SSA does not intend to start issuing 1099s to attorneys until 2009 for calendar year 2008.

Obesity Was Impairment Used In Alleged Disability Fraud In Miami

Yahoo News reports that the alleged disability fraud ring in Miami was using phony claims of disability due to obesity to obtain Social Security benefits. This report lists the names of the 32 individuals indicted. Disability fraud cases are not that common. I doubt that there has ever previously been any alleged Social Security disability fraud on this scale.

Who does this hurt? Obviously, those who have been indicted are in serious trouble, but the damage can go much further. This may be spectacular enough that a Congressional committee will want to hold a hearing -- and if there is such a hearing, Social Security's Inspector General will undoubtedly claim (with no proof) that there is much more of this going on that could be uncovered if he just had more resources. Claimants in general and those suffering from morbid obesity, in particular, may be hurt by an unnecessarily heightened concern over fraud. A state disability determination agency employee is alleged to have been involved in fraud, so there may be new procedures that will slow things down even further at these agencies. Non-attorney representatives are alleged to have been involved in fraud. This cannot help their effort to make withholding of their fees for representing claimants permanent. This could cause Social Security to become suspicious of all medical evidence submitted by claimants or their attorneys or representatives.

More On Florida Fraud Indictments Apparently Involving Non-Attorney Reps And DDS Employee

From LawFuel.com:

According to the Indictment, defendant Carlos Barker was employed by DDS, and was responsible for determining disability eligibility. In essence, the defendants conspired to obtain Social Security disability benefits by preparing and filing fraudulent applications, which included false supporting medical documentation in the names of fictitious physicians or actual physicians who had never examined the named beneficiaries. More specifically, the Indictments allege that the defendants used a company, called Benefits Consultants of Florida (“BCF”), located at 30620 SW 154th Avenue, Miami, FL 33088, to prepare and submit false applications for SSI disability benefits. Defendant Migdalia Interian was the registered agent/director of BCF, and defendant Yoanka Interian was the president of BCF.

According to the charges, various defendants recruited individuals who would agree to submit false applications and supporting medical documents to the SSA to fraudulently qualify the applicants for disability benefits. In exchange for their services in preparing and submitting the false applications, defendants Carlos Barker, Francisco Castro, Migdalia Interian, and Yoanka Interian would keep the first Social Security benefit payment, known as the “retro check,” which would include retroactive payments from the time of the application. Thereafter, the named beneficiary would receive monthly disability payments from Social Security.

New Regs On Medicare Part B Income-Related Monthly Adjustment Amount

Social Security has published in the Federal Register final regulations on Medicare Part B income-related monthly adjustment amount.

Alleged Social Security Fraud In Florida Appears To Involve Non-Attorney Reps And DDS Employee

From the Miami Herald:

Federal authorities today broke up a Miami-Dade County ring that schemed to defraud $2 million in disability benefits from the Social Security Administration, the U.S. attorney's office said.

A federal grand jury returned 25 indictments that accused 34 local residents of participating in the conspiracy, allegedly masterminded by an employee with a state disability agency and a consulting benefits business.

The alleged ringleaders were identified as Carlos Barker, an employee with the Florida Office of Disability Determination Services, and Migdalia Interian and Yoanka Interian of Benefits Consultants of Florida.

They're charged with preparing and filing fraudulent disability applications to the Social Security Administration over the past decade, according to the indictment. They kept the first benefit payments for their work, then the bogus beneficiaries received monthly disability payments.

The 34 defendants, according to court documents, were born between 1938 and 1972.
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Don't Know How To Make The DRB Work? -- Hire A Contractor

Under the Disability Service Improvement (DSI) experiment currently underway in Social Security's Boston Region, the Appeals Council is being replaced by a Disability Review Board (DRB). Claimants will no longer be able to request review by the Appeals Council after they are denied by an Administrative Law Judge (ALJ). This plan has been criticized on the grounds that it would lead to a dramatic rise in Social Security cases being appealed to the Federal Courts. Social Security's response has been that the agency would avoid such a dramatic effect upon the Federal Courts by having the DRB identify cases that are likely to be appealed to Federal Court and then reversed or remanded. The DRB would correct errors in those decisions without the claimant requesting review. When questions have been raised about how this could be done, Social Security's responses have been vague.

We now know why Social Security was so vague on how the DRB would prevent a huge increase in Federal Court filings in Social Security cases. They had nothing more than a vague notion of how they could do this. Social Security has issued a "presolicitation notice" indicating that the agency is seeking a contractor to develop a computer system to screen ALJ decisions for cases that are likely to be appealed to Federal Court and then reversed or remanded.

It is entirely possible that a contractor can develop a system that will work. It is also entirely possible that this will fail miserably, most likely because Social Security's databases do not contain enough data fields to predict results in such a complex situation and it would be too expensive to add those data fields. Even though there is no proof that this computer system will work, Social Security has already enshrined the DRB in regulations. All Social Security can do now is hope a contractor can pull a rabbit out of a hat.

Here is the text of the notice:

The purpose of this notice is to advise interested parties that the Social Security Administration (SSA) intends to release a Requests for Proposals (RFP) for the services of a contractor to develop an automated, Section 508 compliant, profiling/screening tool (software) for identifying Administrative Law Judge (ALJ) disability decisions to FedBizOpps and will upload the solicitation document when issued.

The Social Security Administration (SSA) has a requirement for the services of a contractor to develop an automated, Section 508 compliant*, profiling/screening tool (software) for identifying Administrative Law Judge (ALJ) disability decisions that are likely to be appealed to federal district court and remanded or reversed by the court. The contractor may also recommend the purchase and/or modification of an existing Commercial Off-the-Shelf (COTS) software package for the profiling/screening tool if an existing product can be identified.

On March 31, 2006, SSA published the final rules establishing a new disability determination and administrative appeals process effective August 1, 2006. Under the new rules SSA is gradually phasing out the Appeals Council?s review of disability claims and replacing it with a review by a Decision Review Board (DRB). The DRB will focus on identifying decision-making errors as well as policies and procedures that will improve decision-making at all levels of the disability determination process.

SSA intends to select ALJ decisions for review by the DRB in several different ways, including the use of computer-based predictive screening tools. It is envisioned that a sophisticated computer-based profiling/screening tool could be developed to help identify unfavorable ALJ decisions that contain characteristics associated with federal district court appeals and remands or reversals. The profiling model will be developed using data recorded at the time of the initial level determination, ALJ decision, Appeals Council review, and the court action. This information includes the applicant?s age, education years, primary impairment, reason for the court remand, etc. The methods for selecting cases for DRB review are expected to evolve over time as more data are available and SSA gains more experience and knowledge in the use of computer-based tools. Any software will make use of current SSA databases and systems architecture already available, if applicable.