The Office of the Inspector General (OIG) in its November, 2014 Congressional
Response Report has targeted 44 administrative law judges (constituting about 4% of the total ALJs) for investigation concerning what they consider excessive payment of claims. These ALJs are termed “outliers” by OIG.
The investigation involved analysis of an initial sample of 275 cases and found that only 38 cases should not have been paid.¬† This is only 13.8% which is a nominal amount and fails to demonstrate any bias on the part of the ALJs investigated. Rather than accept such a small number which could be accounted for by the SSA’s own bias, the Administration went on to extrapolate to the ridiculous, estimating payment of nearly 25,000 cases over a seven year period. If this were true, SSA believes the cost to be estimated at $2B in wrongfully paid benefits.
Such an extreme extrapolation made from a very small sample is not statistically supportable by any statistician. But, remember, this is more about politics (as the study was requested by Republican provacateur Dan Issa (R-CA) and Chairman on the Committee on Oversight and Government Reform) than about true reform.
The report also fails to detail the failure inherent in the disability decision review system. All claim approvals are subject to what is termed “own motion” review. Own motion” review is when SSA reviews approved claims for consistency and accuracy of the opinions. Further, SSA has created an early monitoring system and focused quality reviews for the favorably deciding “outlier” ALJs. No such monitoring or quality review exists for claim denying “outlier” ALJs who are permitted to deny benefits with impunity.
Even with the “own motion” review process, only 15% of the favorable decision issuing “outlier” ALJs were subjected to any kind of discipline by SSA. This includes restricted and reduced case assignments, mandatory “re-education” courses or “counseling” sessions, official reprimands, and suspension.¬† Again, no such discipline has been utilized for claim denying “outlier” ALJs.
Of course, there has been no similar study or extrapolation for ALJs who underpay cases (20% or less). These ALJs are clearly “outliers” on the other side of the claim approval spectrum, yet their conduct remains unaddressed. For this reason, it is obvious that this process is purely political and not about fundamental fairness in the process.