Man Convicted Of Stealing More Than $1.5 Million From Social Security and VA

     From a press release issued by Social Security's Office of Inspector General:

United States Attorney Bill Nettles stated today that Dennis Paulsen, age 45, of Blythewood, was convicted of stealing more than $1.5 million from the United States Department of Veterans Affairs and the Social Security Administration following a seven-day jury trial in federal court in Columbia [SC].  ...

After being diagnosed [with Multiple Sclerosis] and discharged from the Navy in the early 1990s, Paulsen began receiving a monthly VA benefit as a result of his diagnosis.  Unsatisfied with the amount he was receiving, Paulsen began a pattern of malingering by claiming his MS rendered him unable to use his hands or feet in any respect.  Still unhappy with the money he was awarded, Paulsen ramped up his claims, lying to his doctors, presenting himself as house- and wheelchair-bound, and making false claims that he required daily professional medical care to live until his benefits were increased to the maximum disability payments available to a Veteran.  At the same time, Paulsen used the same feigned impairments to convince the Social Security Administration that he was entitled to Social Security disability benefits.  Despite his feigned claims of impairments and presenting himself in a wheelchair to his doctors, Paulsen lived in a non-handicap accessible residence and was able to ride his motorcycle and jet skis plus play baseball and golf on a regular basis. ...

The extensive investigation by the VA and SSA included undercover agents, surveillance, and photographs and video footage from banks, stores, and the Columbia Metropolitan Airport. Family photographs kept by Paulsen’s ex-wife were also obtained showing Paulsen’s many activities with his family, playing baseball, and participating in a Marine Mud Run. Paulsen testified, in a wheelchair, for four hours and called three doctors as expert witnesses in an attempt to support his claim that he was and had been totally disabled. The guilty verdict reflects that the jury did not find this testimony credible.

     MS is a strange disease. A person with relapsing and remitting MS can have dramatic fluctuations in their functional abilities. They can legitimately go from having few symptoms to being in a wheelchair to again having few symptoms over the course of a few weeks. A jury convicted this man so I assume the evidence against him was strong but an MS patient who tells a story of severe symptoms that come and go may well be telling the truth. If you deal with MS patients at all, you really get struck by how strange MS is.

Doctor Indicted For Fraud

     From the Philadelphia Inquirer:

... Federal prosecutors Friday unsealed an indictment charging a Wynnewood doctor with Social Security fraud. 

Frederick Douglas Burton, 67, of the Burton Wellness & Injury Center on City Avenue in Wynnewood, has been charged with two counts of mail fraud and attempted mail fraud.

He is accused of defrauding the Social Security Administration by signing and sending letters on behalf of another doctor, Dennis Erik Fluck Von Kiel, of Lehigh County. 

The two letters, sent in the fall of 2013 to a law firm that helps clients obtain Social Security disability benefits, falsely contended that Burton had been treating Von Kiel for about seven years, and that Von Kiel suffered from post-traumatic stress disorder and was unable to work, according to the U.S. Attorney's Office in Philadelphia. ...

Old Age And Survivor Trust Fund Keeps Growing

     Social Security has posted the final 2015 numbers for the Old Age and Survivor's Trust Fund. Please note that despite the gloom and doom from the right that the Trust Fund reserves keep increasing and now stand at $2.8 trillion. That's trillion with a T. I'm sure that we'll hear the right say that this proves that SOCIAL SECURITY IS DOOMED TO FAIL. They've been proven wrong for more than 80 years but they keep bellowing the same thing. Koch brothers money buys a lot of bellowing.

Old-Age and Survivors Insurance
(Amounts in millions)

Calendar year	Total income	Total outgo	Net increase in asset reserves	Asset reserves at end of calendar year
2011	$698,781	$603,750	$95,031	$2,524,075
2012	731,075	645,482	85,593	2,609,668
2013	743,793	679,475	64,317	2,673,985
2014	769,417	714,170	55,247	2,729,233
2015	801,561	750,542	51,019	2,780,251

Prior Claim Files

     I wonder if someone could confirm something for me. I've heard that in Social Security disability cases prior claim files, as long as they are electronic, are linked to current electronic claim files in some fashion and are easily available to those adjudicating the new claim. Is this accurate?
     The problem for me is that the prior claim files are not available to attorneys representing claimants. If these files are available to an Administrative Law Judge (ALJ) hearing a case, shouldn't they also be available to the claimant and his or her attorney? I can hear the response, "Well as long as I don't make them an exhibit, what's the problem?" The problem is two-fold. First, how do I, as the claimant's attorney know that you haven't looked at them? It's possible to look at something without making it an exhibit. I'm not implying some impropriety. My impression from things I've heard is that many ALJs believe that if something was made an exhibit at a prior hearing, it remains an exhibit at a hearing on a new claim and is available to the attorney representing the claimant but it isn't. Second, the prior file may include valuable information that would help in the adjudication of the new claim. If ALJs aren't looking at the prior claim files, they should be.

The CARES Plan

     Social Security's plan for dealing with its hearing backlog has leaked out. It's called CARES, standing for "A Plan For Compassionate And REsponsive Service." Here's another link to the plan, although this second link will expire on January 29.
     The plan is awfully reminiscent of prior plans to deal with the backlog. Here are the elements of this plan as I see it:

• Assumption that the most important element is better management. Current management is much smarter than the people who used to manage the Office of Disability Adjudication and Review (ODAR). Of course, they were idiots. Look at the backlog! Of course, the new guys are smart. Look at that great graphic on the cover of the report. Anybody who can produce graphics like that must have a great plan.
• Vague management initiatives. The new management initiatives consist of mere concepts that have little hope of succeeding but the new managers are so much smarter than the old managers that, of course, the new initiatives will work.
• Unrealistic assumptions about future appropriations. The plan is based upon Social Security getting all the appropriations it desires. However, in the real world, as long as the GOP controls the House of Representatives, the agency's budget may see little improvement. It may be difficult to maintain current staffing levels, much less improve them.
• The assumption that it is essential that the process be controlled so that allowance rates on disability claims remain at historic lows. Keeping approval rates low is referred to as "quality." If anything, it looks like there will be new initiatives to improve "quality." "Quality" concerns will almost certainly prevent the issuance of many staff attorney decisions.

     What I see here is an unappealing mixture of arrogance, wishful thinking and cowardice. Everyone knows what would help considerably even at current funding levels -- aggressive use of the senior attorney program and encouraging Administrative Law Judges to do on the record reversals in appropriate cases. Social Security management is afraid of offending the GOP by approving more claims so they don't do what they know would work.
     If I sound bitter, it's because I am. I'm out there dealing with the claimants whose lives are being destroyed by the backlogs while Social Security management seems more interested in producing great graphics than in actually doing something about the problem. What's needed is the courage to admit the obvious and do what needs to be done. Instead, we get nonsense like this which only encourages Republican budgetary obstinance. Why give the agency more money when the agency itself is telling you what you want to hear -- that they can manage their way out of the problem? Don't expect Republicans to pay attention to the rosy prediction in CARES that the agency will get more money so it can hire more workers. They will ignore that and demand that Social Security solve its backlogs without additional money while making sure that it's horribly difficult to be approved for disability benefits.

Finally!

     Social Security has announced that its central offices in the Baltimore area will be operating on a normal schedule tomorrow. 

     Among other effects, the three days of closure due to the snowstorm have added to the backlog of people awaiting payment of disability benefits after a favorable decision and to the backlog of people awaiting action from the Appeals Council. 

     Even with the offices reopening, things will not be back to normal if schools remain closed. Employees can't leave their young children at home alone. Perhaps some locals can update us on the school situation.

Rep Payees Remain A Problem

     From a recent report by Social Security's Office of Inspector General (OIG) (footnotes omitted):

A representative payee receives and disburses benefit payments o n a beneficiary’s behalf. Congress granted SSA [Social Security Administration] the authority to appoint representative payees for those beneficiaries whom SSA deems are incapable of managing or directing the management of their benefit payments because they have a mental or physical disability or are a child. A representative payee may be an individual or an organization. ...

SSA procedures prohibit volume individual representative payees from collecting a fee from SSA benefits except in certain circumstances, such as court-ordered fees, including fees for serving as a court-appointed legal guardian. ...

Since 2007 , we have conducted seven in - depth reviews of high-volume individual payees. All these payees had more than 50 beneficiaries in their care at the time of our r eview. In total, these payees served m ore than 1,000 beneficiaries. ...

Because of the extensive level of our review, we identified several recurring findings — including payees collecting unallowable and /or excessive fees. Specifically, we noted that all seven payees collected fees — many in excessive amounts — to compensate for their services, despite SSA policies to the contrary. Yet, of the 43 payees SSA reviewed with 50 or more beneficiaries, SSA only identified 4 as having collected fees. ...

We used the research tool LexisNexis to review the 47 high-volume individual payees. We noted that six payees had prior financial liens and judgments or bankruptcy filings. The mos t recent lien was filed in 2009 , which is the same year that the payee was selected by SSA. According to LexisNexis, this lien was released in 2011. ...

For example, one payee served only as the representative payee for one beneficiary whom the payee charged $1,592 for unallowable fees. In addition, for 34 of 80 beneficiaries, the payee collected extra fees totaling $49,423 above the allowed monthly guardianship fee of $60. This payee also collected large fees , totaling $113,526, from 2 of the 80 beneficiaries....

In September 2015, our Office of Investigations informed us that the Washington County Grand Jury had indicted 1 of the payees in the Seattle Region for 81 criminal counts including criminal mistreatment in the first degree, aggravated theft, and income tax evasion. This payee was included in our population of the 449 payees caring for between 15 and 49 beneficiaries. She had 45 beneficiaries in her care when the investigation was initiated in October 2014. According to available information, the representative payee filed for bankruptcy in 2001, and a Federal tax lien was filed in 2004 before she became a payee for SSA. Given the fiduciary responsibilities of a representative payee, it may be inappropriate to give those responsibilities to an individual who has claimed a personal bankruptcy and/or has a Federal tax lien.

     Before you criticize Social Security, remember that there aren't people lined up wanting to be representative payees. In many cases, it's hard to find any person or entity willing to do the job and, no, there really isn't an alternative to using rep payees. Some people just can't handle their own funds.

Central Offices Remain Closed

     Social Security's central offices in the Baltimore area remain closed today due to the severe snowstorm that hit last week.