Doctor Pleads Guilty

      From a press release:

Defendant Americo Oms-Rivera plead guilty before United States District Judge Francisco A. Besosa to conspiracy to commit wire fraud ...

The defendant admitted that starting on March 2009, until on or about October of 2015, the defendant and other co-conspirators knowingly and willfully conspired and agreed together and with each other, to devise a scheme and artifice to defraud the SSA, and to obtain money and property by means of materially false and fraudulent pretenses, representations and promises. For example, Oms Rivera would backdate medical records of patients applying for disability insurance benefits by creating fictitious medical appointments that never took place. This was done to create the appearance of a longer history of medical treatment and for the purpose of tricking or deceiving the SSA into approving disability insurance benefits.

As part of the plea agreement, Oms Rivera will pay SSA $321,000 in restitution, and agreed to the forfeiture of a property at Palmas del Mar, Humacao.  In addition, Oms Rivera will surrender his DEA license, and will be excluded from participating in SSA cases, as well as Medicare, Medicaid and all other federal health care programs. ...

Arrests In International Fraud Scheme

      From a press release:

Two Riverside County [CA] men were arrested today on an indictment alleging they participated in an international conspiracy that deceived elderly victims into sending more than $500,000 in cash by pretending to be federal agents threatening them with arrest on bogus warrants.

The federal grand jury indictment unsealed today charges a total of three Lake Elsinore residents with conspiracy to commit mail fraud and wire fraud:

• Anuj Mahendrabhai Patel, 30, a.k.a. “Mike” and “Indio”;
• Elmer Miranda Barrios, 35, whose aliases include “Welbin Raul Mejia” and “Joe Rodriguez”; and
• William Margarito Barrios, 36, Elmer Barrios’s cousin, who faces an additional charge of being an illegal alien who re-entered the United States following deportation....

According to court documents, from April 2019 until March 2020, other members of the conspiracy, some of whom are believed to be in India, telephoned victims and pretended to be government employees or law enforcement officers. Using a number of false pretenses – including phony badge numbers and using spoofed government telephone numbers – the co-conspirators convinced the victims, most of whom were over the age of 55, that their identities or assets were in trouble. 

For example, some victims were told that their Social Security numbers had been linked to crimes and that there were warrants issued by courts authorizing the victims’ arrests. The co-conspirators further told the victims that in order to clear the warrants, they should withdraw their savings and send cash by mail to other members of the scheme. ...

The total loss alleged in this case is approximately $541,420 ...

Disability Claims Filed And Approved Continue To Decline

 

     Social Security has posted updated statistics showing the number of disability claims filed and approved through the end of September. Here are the numbers of claims received at Disability Determination Services (DDS) by quarter this year:

• Q1 -- 325,683
• Q2 --  306,518
• Q3 -- 296,974

 And here are the numbers of awards at all levels:

• Q1 -- 196,386
• Q2 -- 163,629
• Q3 -- 149,909

     There is a very important footnote to these stats telling us that:

Because the application data are tabulated on a weekly basis, some months include 5 weeks of data while others include only 4 weeks. This weekly method of tabulation accounts for much of the month-to-month variation in the monthly application data. This method also occasionally causes quarterly data to have either 12 or 14 weeks of data instead of 13 weeks, annual data may include an extra week of data.

      Despite the footnote, it seems clear that there has been a big decline in the number of disability claims filed and approved over the course of 2020. If you were of the opinion that the number of disability claims is strongly related to the unemployment rate, you've been proven spectacularly wrong, at least for this year. And don't try to say the decline in disability claims filed is due to the special Pandemic Unemployment Assistance. Those ended on July 31. If that was what was holding down the number of disability claims we should have seen a dramatic increase in claims filed after it ended but, instead, they kept going down.

     I think that the number of claims filed is down due in large part to the increased difficulty that people have filing claims. I don't know what else it could be. Some people need more help than others.

EM On Representation Of Claimants

      For whatever reason, Social Security has seen the need to issue an Emergency Message reminding its staff that claimants often have representation and that there are statutes, regulations and policies concerning the agency's dealing with those representatives. Perhaps some may have thought that due to the pandemic the basic rules could be ignored. 

     By the way, for those who don't know, Social Security "Emergency Messages" don't normally address emergencies. Of course, by this point we don't know what most of the "Emergency Messages" do address. So far this year, the agency has released at least 49 Emergency Messages to its staff but has released only 4 of those to the public. Government in the sunshine? Not so much at Social Security.

Attorney User Fee Goes To $98 Beginning In December

      Social Security earlier announced the 1.3% COLA (Cost of Living Adjustment) for benefits for 2021. Tomorrow the agency will publish a more complete notice about all of the COLA adjustments in the Federal Register tomorrow. Perhaps the item on that list that will attract the most attention, at least from one group, is the increase in the maximum user fee charged to attorneys and others who represent claimants before the agency. That amount goes up to $98 beginning in December. The user fee is deducted from the fees that the attorneys receive. 

     Of course, no adjustment was made in the maximum fee that attorneys may charge their clients under the fee agreement process. My understanding of Social Security's position on that is that they will consider raising that amount once it is reliably reported to them that representation has disappeared. We may be in a situation comparable to that which once existed for representation of veterans. In 1864 Congress passed a $10 cap on attorney fees for attorney representation in veterans benefits matters. That may have been reasonable at the time. However, no adjustment was made in that cap for 120 years! That cap protected veterans so well that attorney representation in veterans benefits cases disappeared apart from pro bono representation. I imagine that there are those at Social Security who would be happy to see the same thing happen at Social Security.

But Will They Have Enough People To Answer The Phones?

     From a press release:

The Social Security Administration (SSA) has chosen Verizon to provide Unified Communication (UC) and Contact Center (CC) services to more than 62,000 SSA employees at 1,300 locations through The Next Generation Telephony Project (NGTP). This project focuses on converging three existing systems to provide an enterprise-wide CC and UC solution upgrade for the SSA.

Verizon will provide a customized UC/Customer Experience platform that will help the SSA transform customer service as part of its long-term IT modernization plans. The project includes complete operational support services including management, maintenance, training, help desk, network operations center, security, recording and analytics. It also enables the SSA to analyze operations more effectively, improve customer experience and better serve the public across channels, whether in-person, video, phone or online. ...

Verizon will also play an instrumental role in replacing SSA’s national 800 number teleservice platform, which supports over 10,000 agents and field office employees who respond to citizen inquiries regarding their SSA benefits.

Personnel News

      From Federal News Network:

Rajive Mathur, the Social Security Administration’s deputy commissioner and chief information officer, is leaving after more than two years in the role.

Federal News Network has confirmed Mathur’s last day as CIO [Chief Information Officer] will be Oct. 26. SSA Commissioner Andrew Saul said in an email to staff, which Federal News Network obtained, that until his departure at the end of the year, Mathur will work in the commissioner’s office as a senior advisor.

Saul also said Sean Brune, currently the assistant deputy commissioner and deputy CIO, will be the deputy commissioner and CIO starting on Oct. 26 when Mathur moves to the commissioner’s office. ...

Saul also announced two other personnel changes at SSA.

In the Office of Analytics, Review and Oversight, the improper payments function moves from the Office of the Deputy Commissioner to the Office of Anti-Fraud Programs — which is now renamed the Office of Program Integrity.

In the Office of Operations, Travis Dodson, currently the center director for Disability and Programs Support in the Dallas Region, will begin an assignment as the acting deputy regional commissioner, Dallas.

SSAB Recommendations On Disability Claims Improvement

      In 2018 the House Social Security Subcommittee requested that the Social Security Advisory Board (SSAB) examine Social Security's reinstatement of the reconsideration stage of appeal in disability claims and to recommend improvements at the initial and reconsideration stages. SSAB is only now getting back to the Subcommittee with a full report.

     SSAB assembled five panels to discuss possible improvements. What the panels recommended mostly seems vague to me. For instance, one recommendation is "Simplify SSI eligibility for children." That's certainly a worthy goal but if you know any history of SSI child disability, you know that if you want "simplification" you'd better say exactly what you have in mind -- and then duck because whatever you have in mind will be extremely controversial. Recommendations that are more specific, such as "Simplify the SSI program by eliminating the living arrangement eligibility requirement, windfall offset, dedicated accounts, and in-kind support and maintenance" can only happen if there are major changes in the political environment. We'll see about that after November 3.