Broadcast E-Mail On Disability Fraud

A Message To All SSA and DDS Employees

Subject:  Fraud Prevention and You

Date:  January 15, 2015

The Department of Justice in Puerto Rico today announced the indictment of 40 individuals, including a medical provider, on charges relating to SSA disability fraud.  These indictments demonstrate the effectiveness of our numerous fraud detection and prevention initiatives, which rely heavily on the continued vigilance of our SSA and DDS employees.  SSA employees identified and reported this potential fraud to our Office of the Inspector General (OIG), and provided analysis to OIG during the investigation.  The success of the investigation and the resulting indictments can be directly attributed to the ongoing partnership and collaboration among SSA, the DDSs, OIG, and the Department of Justice .

Preserving the public’s trust in our programs and reducing improper payments is a critical element of our work.  As you know, one of the key elements of our strategic plan is to prevent fraud, waste, and abuse.  We take pride in our efforts to reduce improper payments as we aggressively seek to ensure that only those entitled to benefits receive them.

We have undertaken a number of measures recently to combat fraud and abuse in the disability program, including:

• The establishment of the Office of Anti-Fraud Programs to lead our anti-fraud efforts;
• The re-establishment of our National Anti-Fraud Committee;
• A significant increase in the number of Continuing Disability Reviews (CDR) we complete;
• A significant expansion in the number of Cooperative Disability Investigations (CDI) Units, as well as increasing our staff in many existing Units;
• Anti-fraud training for all SSA and DDS employees;
• The establishment of robust data analytics capacity to enhance fraud detection;
• The establishment of three Fraud Prevention Units made up of expert disability examiners who review and act on potential fraud cases; and
• An increase in the number of our attorneys who serve as Special Assistant United States Attorneys dedicated to prosecuting Social Security fraud.

Our first line of defense is each of you!  I cannot over-emphasize the importance of reporting suspicious or questionable facts that come to your attention in the course of your daily work.  As individuals become more adept at discovering ways to try to defraud SSA, we must be even more vigilant and attentive to details that may suggest fraud, including those that we may not ordinarily consider. 

The following is information about identifying and reporting suspected fraud that you may find helpful.

• POMS GN 004100ff [this section of POMS must not be available to the public since the link doesn't work] provides additional information on fraud awareness and reporting. 

• The electronic 8551 (e8551) is used by SSA and the DDSs to report allegations directly to OIG.  A link to the e8551 can be found at:  Reporting Fraud e8551 [again, the form must not be available to the public]. 
• For the public, we have set up a special Puerto Rico CDI Hotline to report Program fraud in the Commonwealth of Puerto Rico.
• For all other public reporting, the OIG fraud Hotline: 1-800-269-0271 is available (10 AM to 4 PM EST).
• For additional public reporting options, please refer to http://oig.ssa.gov/. 

I want to reassure you that SSA is fully committed to working with our Federal and State partners to ensure that we vigorously pursue prosecution of individuals or groups who attempt to defraud our programs.  I want to thank each of you for the work you perform to support our mission and remind you that, if you see something suspicious or questionable, please do not keep it to yourself.  Report it!

Pete Spencer

Co-Chair

National Anti-Fraud Committee

The 80-Year War Against Social Security

     Dylan Scott at TPM gives a history of The 80-Year Conservative War On Social Security.

House Ways And Means Committee Press Release On Arrests In Puerto Rico

     A press release from the House Ways and Means Committee:

WASHINGTON — Today, the U.S. attorney’s office in Puerto Rico announced additional indictments based on work begun over five years ago to bring fraudsters to justice. 

Upon hearing this news, Subcommittee on Social Security Chairman Sam Johnson (R-TX) stated:

“Today’s arrests in Puerto Rico are yet further proof that the disability program is plagued by widespread fraud. While it is critical that those who committed fraud are held accountable, the bottom line is that success is not discovering massive fraud schemes— success is preventing fraud in the first place. That is the only way hardworking taxpayers’ dollars can be protected.

"As chairman, I’ve already asked Inspector General O’Carroll for a top-to-bottom review of the disability program. I’ve also asked Acting Commissioner Colvin for her plan to do better when it comes to preventing fraud. With the disability program going insolvent in 2016, it is more important than ever to stop fraud that is costing the program precious taxpayer dollars and undermining public confidence in the program. 

"As chairman I will continue to work with my colleagues to keep the disability program strong for those who truly need it and the recently passed House Social Security rule to is a step in the right direction.”

Among the new revelations brought to light today, the Office of the Inspector General (OIG) of the Social Security Administration (SSA) revealed:

·       The overall fraud loss from this scheme is now estimated to be over $100 million. They expect this investigation will result in a projected lifetime savings to Social Security and taxpayers of more than $160 million.

·       This investigation dates back to November 2009, when the SSA forwarded an allegation to its OIG involving suspicious Disability Insurance benefit claims filed in Puerto Rico that involved nearly identical medical documentation.

·    In August 2013, 74 people, including four medical professionals and a non-attorney claimant representative, were indicted and arrested for their involvement in this disability fraud scheme.

·       As of today, 39 of these defendants have been sentenced, receiving probation terms of one to three years, and, in some cases, 30 days in prison. All those sentenced or issued pre-trial diversion agreements will make full restitution to the SSA. Court-ordered restitution for these defendants totals $1,169,034.

·       Today, the U.S. attorney’s office in Puerto Rico announced the indictments of an additional 40 people, including a psychiatrist, for their alleged involvement in this conspiracy. As of this morning, 39 of 40 defendants have been apprehended. These indictments and arrests are a result of continued work by the SSA OIG, the Federal Bureau of Investigations, and the Puerto Rico Police Department as part of the overall investigation.

But Does He Meet The "Hop Out Of A Truck" Test?

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The "Hop Out Of Your Truck" Test

     Senator Rand Paul on disability:

What I tell people is, if you look like me and you hop out of your truck, you shouldn’t be getting your disability check. Over half of the people on disability are either anxious or their back hurts. Join the club ... Who doesn’t get up a little anxious for work every day and their back hurts. Everybody over 40 has a little back pain.

     Over half of all applications for Social Security disability benefits do come from people whose primary health problem is either mental or musculoskeletal. This includes people disabled by schizophrenia, traumatic brain injury, multiple amputations and spinal problems causing paraplegia. "Either anxious or their back hurts" is misleading. It's like describing someone with no light perception in either eye as being a little near sighted. One problem is that many on the right believe that what Paul said is true. A bigger problem is that Paul probably believes that what he said is true.
     If you believe that government paid disability insurance benefits are wrong, say so. Don't resort to outrageous misrepresentations of the program you oppose.

     Update: Paul has received a fair amount of criticism for his comments. His response is that those criticizing him are " ... arguing for fraud ... I'm arguing for eliminating fraud." That makes sense only if you believe that the vast majority of people drawing disability benefits are doing so fraudulently.

     I sometimes think that the only test for disability that folks like Paul would accept is that it must be immediately obvious to anyone at any time that the person is disabled and also that it must also be immediately obvious to anyone at any time that the person is suffering badly.

Coburn Angry That Conn Not Prosecuted

     From the Huntington, WV Herald-Dispatch:

The Oklahoma senator who led a Congressional investigation into alleged disability fraud at Huntington's Social Security Office took a parting shot at justice officials for not prosecuting those involved.

Tom Coburn, R-Okla., delivered his criticism from the Senate floor as he walked into retirement last month. He singled out U.S. Attorneys in southern West Virginia and eastern Kentucky, saying both recused themselves from prosecuting Eric Christopher Conn.

House and Senate investigations targeted Conn, a disability claims attorney near Pikeville, Ky., as well as former Social Security administrative law judges David B. Daugherty and Charles Paul Andrus.

Coburn argued the alliance of Conn and Daugherty, coupled with lacking oversight from Andrus, amounted to a "slam dunk." ...

The Dec. 16, 2014, floor speech called it a failure of the Justice Department to be "handed an absolutely, totally perfect case" and not prosecute those taking advantage of the system. Coburn particularly took issue with Conn's continued ability to represent disability claimants before the Social Security Administration.

"I wonder what (Conn) has over them," he said of the prosecutors. "I wonder what it is when you have a closed case, a prosecutorial case that you have to do no work on and the U.S. Attorneys will not prosecute a thief of the highest order." ...

Coburn's floor speech indicates the matter now rests with Social Security Inspector General Patrick P. O'Carroll, Jr., who the now retired senator said was trying to convince the Justice Department's criminal division in Washington to take action.

     The Kentucky Bar Association has apparently decided against trying to discipline Conn. So far, Social Security hasn't disciplined Conn. Neither of those cases would require proof beyond a reasonable doubt, just by the preponderance of the evidence. And, yet, Coburn is certain that the case against Conn is a "slam dunk", "absolutely, totally perfect" that could be proven beyond a reasonable doubt in a criminal court? Maybe the case isn't as airtight as Coburn thinks. Maybe Coburn should stick to medicine and politics and leave prosecutorial decisions to prosecutors.

"Concerned About The Public Perception"

     From CBS News:

People who owe old debts to the Social Security Administration are getting a reprieve this tax season: The federal government won't be seizing their tax refunds.Acting Social Security Commissioner Carolyn Colvin suspended a debt collection program last spring in which thousands of people had tax refunds seized to recoup overpayments that happened more than a decade ago. ...

Following a review, the agency said Monday it will continue suspending the program this tax season while officials explore possible changes.

"The commissioner is concerned about the public perception about the way we're running this program," said Pete Spencer, Social Security's deputy commissioner for budget, finance, quality and management. ...

Number Of People Drawing Social Security Disability Benefits Leveling Off

     As of November 2013 there were 8,941,660 people drawing Disability Insurance Benefits (DIB) under the Social Security Act. As of November 2014, the most recent month for which numbers are available, there were 8,956,269 people drawing DIB, an increase of 14,609 people or less than a fifth of one percent, from the year before. By contrast, the number of people drawing DIB went up by 136,307 or 2% between November 2012 and November 2013. In each of the last two months reported, the number of people drawing DIB has actually gone down.

     Social Security's Office of Chief Actuary had forecast that there would be 9,014,000 people drawing DIB by the end of 2014. Unless there was a huge jump in the number of DIB recipients last month, the forecast was off by a not insignificant number.

     We'll see how 2015 and 2016 go but it's entirely possible that the number of people drawing DIB will be going down as the debate rages in 2016 on what to do about the impending exhaustion of the Disability Trust Fund. Also, it's not clear just how impending that exhaustion date will be in 2016.