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So, How Good Are the Decisions Written by Your Administrative Law Judge

In March, 2017, the Office of the Inspector General (OIG) for the Social Security Administration (SSA) issued a report which addressed the quality of decisions issues by administrative law judges (ALJs) following Social Security hearings.

As a preliminary point, the Appeals Council (AC) routinely monitors cases in which ALJs approve benefits in order to verify the quality of the written decision. Denials which are appealed to the AC are automatically reviewed as part of the appeal process following an appeal from an ALJ hearing denial.

SSA has been tracking “decisional quality” since 2014 which is defined as whether the Appeals Council agrees with ALJ benefit approval decisions. Prior to this report, ALJ decisions were approved 85% of the time, the previously set “agreed rate average.”

The current report details that 310 ALJs do not meet with agreed rate average. Worse yet, 27 ALJs had agree rates below 65%. Corrective action has been undertaken on only a handful of these ALJs

Even more disturbing is the fact that 10 Hearing Offices had decision agree rates below the established norm. No action is being taken concerning the particular offending Hearing Offices.

These are imperfect findings as denied claims must be appealed to the Appeals Council for review to be considered. For this reason, less than 25% of all ALJ decisions are eligible for consideration.

There is a separate review mechanism for dismissal denials. These are cases which are dismissed for technical reasons for which no hearing his held. The dismissal “agree rate” is only 72% , meaning that 28% of dismissals are expected to be done improperly. This is of little surprise as dismissals are routinely used by many ALJs as a means of adjudicating claims in an expedited and often unfair manner. Given the technical nature of the denials, a very high agree rate should be established. But, this would not allow SSA to resolve its backlog of approximately one million cases as quickly.

Due to the limited information provided by reviewing less than 25% of decisions, most of which are not claim denials, OIG has recommended that national agree rates for denials should be established and monitored. SSA has agreed with the recommendation.

This agreement is surprising, but this counsel remains dubious. Nearly 20 years ago, SSA announced its initial review program which included only favorable decisions. At a national conference, this counsel asked a high ranking SSA employee why denial decisions were not routinely reviewed. No answer was forthcoming. It can only be hoped that the culture at SSA has evolved to the point of acknowledging that many of its ALJs use improper “denial formulas” in writing their decisions which would not pass muster if reviewed by the AC.

At the present date, only 44% of hearings result in a granting of disability benefits. It is time the high 56% case denial rate attracts attention and requires review of claim denial decisions.

Posted in Social Security Administration, SSA |


Challenges and Concerns at SSA – Fall, 2016

The good news at the Social Security Administration (SSA) is that more hearings are being scheduled, coming close to the rate of hearings going on three years ago before the great slowdown resulting in a backlog of over one million hearing level cases.

Obviously, allowing delays to where one million hearing cases exists is a national disgrace. Most of the persons waiting for hearings are citizens who paid into the Social Security system throughout their work lives. At a time when an estimated 63% of Americans cannot afford an unexpected bill of $500, it is a given that waiting for a hearing for one to two years will result in bankruptcy, loss of homes, loss of cars, and, in more cases than it should occur, loss of a supporting spouse. Putting citizens through financial misery in order to receive a relatively small monthly benefit is reprehensible. In 2016, the average monthly benefit is $1,116 with a maximum benefit of $2369 for top wage earners. No one is “living large” on Social Security disability benefits.

But, of course there remain challenges to the system which are preventing SSA from clearing the hearing backlog. The first problem is the ongoing concern of Congressional funding. As it stands, the SSA allotted budget is insufficient to fund ongoing operations without up to two weeks of furloughs for employees during which time all offices would be closed to the public. Further, a full hiring freeze would be instituted resulting in service degradation as well as increased wait times and system delays. This would only put more hardship upon this nation’s most vulnerable citizens.

The budget problem is long simmering in nature with its budget shrinking 10% since 2010 while beneficiaries have increased 12%. The current fight concerns President Obama’s request for a $522M in increase in funding for 2017 while House Republicans have countered with a $772M cut in funding including a spending reduction of $582M.

Further, Acting SSA Commissioner Carolyn Colvin has been in her position since 2/13/13 without ever being installed as in the position of full Commissioner of SSA. House Republicans are responsible for this inaction as well.

Not all the blame goes on the GOP. A substantial number of administrative law judges (ALJs) have become discontented with SSA’s requirement that they schedule 50 hearings a month in order to increase processing of cases and clear the immense backlog. Some ALJs have taken the approach of scheduling 50 hearings a month, then continue many cases for invented reasons such as needing additional evidence, allowing a vocational evidence to review new evidence, ordering a consultative examination, among other excuses. This conduct reduces the number of cases for which decisions are rendered. Further, when the delayed cases are rescheduled, the are again counted toward the 50 cases of the subsequent month. In this way, ALJs are passively resisting doing more work in order to reduce the hearing backlog.

For these reasons, it is clear that SSA faces challenges from outside and within which will prevent the clearance of the one million case backlog for any time in the forseeable future.

Posted in Social Security Administration, SSA | Tagged , , |


Social Security Funding Status 2015

The Social Security Administration (SSA) has reported concerning the funding status for its programs for fiscal year 2015.

The good news is that the Old-Age and Survivors Insurance, and Disability Insurance (OASDI) Trust Funds are projected to become depleted in 2034, the same as projected last year. Once depleted, persons receiving benefits will have their benefits automatically decreased to 79%. On its own, the Disability Insurance Trust Fund will become depleted in 2023, extended from last year’s estimate of 2016 with 89% of benefits remaining payable after depletion. As it turns out, the asset reserves for the OASDI Trust Funds increased by $23B in 2015 with the combined funds still growing. This growth is expected to continue through 2019 after which the program costs are expected to exceed income. In 2015, SSA paid 60 million people benefits.

The outlook for the Medicare Program is not as rosy. In 2015, the Medicare Program covered 55.3M persons of which 46.3M were aged 65 or older and 9M were disabled. 2015 expenditures were $647.B with total income received of only $644.4B. The fund depletion date is estimated to occur by year 2028, two years earlier than reported last year. The only good news is that a projected surplus is projected for years 2016 – 2020 after which funding deficits are expected. Overall, until 2016, the Medicare Program had been running deficits since 2008.

Posted in Medicare, Social Security | Tagged , |


Never Out with the Old at the Social Security Administration

The May, 2016 report from the Office of Inspector General (OIG) for the Social Security Administration (SSA) addressed the Disability Case Processing System (DCPS) being developed by SSA to perform its work.

Since 2008 when SSA decided to proceed with the DCPS system, it has invested over $300M into the project and has endured many delays. This amount is equivalent to nine years maintenance on the current systems utilized. The DCPS systems project appears to have failed and will be of little benefit. Even if implemented, the first stage of implementation for only limited use would cost between $90 – 165M with no estimated accounting for operating costs for the new system once implemented. No cost estimate has been placed for full project implementation.

Given the problems experienced, OIG has recommended that SSA discontinue its efforts to develop DCPS in November, 2014. SSA decided to proceed further with the project instead.

In 2015, a review by the United States Digital Service (USDS) identified significant concerns with the software including coding problems and an overly complex database design which led to degraded performance. Based on these findings, SSA finally decided to discontinue development of the DCPS software. The new monies invested into trying to prove the usefulness of the software were approximately $23M.

Following discontinuation of the specialized software, SSA decided to pursue another avenue and utilize commercially available software. This was termed the “Core” approach. The first release of the Core Sytem is due between July and December, 2016, at a cost of $90 – 165M. In redeveloping the DCPS system, SSA believes it can reuse 22% ($71M) to develop the Core functionality. In other words, it will have wasted approximately $300M in the unsuccessful development efforts invested into the DCPS system.

The OIG report criticizes SSA for its failure to discontinue its efforts to develop the DCPS and continuing to rely on maintenance on its old systems. In addition, SSA was faulted in failing to address “critical functionality that could have had a significant effect on the long-term costs and schedule.”

What concerns OIG is that SSA has failed to undertake any comprehensive analysis of alternatives to its current system. Without such consideration, it cannot be determined if the system can be simplified in terms of support and maintenance so as to reduce infrastructure costs. Moreover, SSA failed to provide detailed documentation of the assessments it did undertaken, preventing any independent evaluation of the reasonableness of its decisions.

This ordeal is a perfect example of a “Golden Fleece” awardee if Senator William Proxmire (D-Wis, 1957 – 89) ) were still with us today. This is a tremendous waste of government resources with little oversight or regard to the taxpayer.

Posted in Social Security, Social Security Administration, SSA | Tagged , , , |


The Aftermath of a Social Security Denial

If you lose a Social Security hearing, you should not give up hope. This is confirmed by the Office of the Inspector General Report from April, 2016 studying case denials from 2011. A survey of cases from that year revealed that nearly 30% of cases were paid on appeal with nearly another 30% of cases paid upon new application and not requiring another hearing.

So, what can you take away from this? First of all, this report would have been more useful if it included the percentage of denied cases taken upon on appeal. For example, if only 50% of cases were appealed following a claim denial and 30% were successful, that would translate to a 60% win percentage. That would be really good. Also not defined are the percentage of cases that lose at the Appeals Council and are subsequently appeal to the federal court. But, even at the 30% rate as stated, why on earth would you not appeal? A one in three chance of getting benefits for pursuing your case is well worth it.

Even if the appeal is not successful, a new application could be filed thereafter, giving you another nearly 30% chance of receiving your disability benefits.

Therefore, both routes combined result in a possible benefit granting in 60% of cases. And, since there is no penalty for appeal and losing or for filing a new application after an unsuccessful one, you should not be discouraged from pursing your case following an initial.

So, what is the downside to this equation: TIME. An appeal to the Appeals Council will take the better part of a year with a federal court case taking at least another six months. Even if you take the approach of filing a new appeal, it does not end up in the lucky near 30% of decisions granted prior to hearing, then you will wait the better part of two years to get another hearing for your eventual “do over.”

Again, the technicalities of dealing with SSA can be very confusing for claimants, many of whom do not realize that competent representation in the first place gives them a greater than 50% chance of winning their case as opposed to those going it on their own.

Hopefully, these statistics are helpful to you and we remain available to consult should you need representation or have further questions.

Posted in Social Security | Tagged , |


Why Was My Short or Long Term Disability Claim Denied?

Believe it or not, this may the most frequently asked question we hear from clients. The problem is that clients are so focused upon their individually-centered existence that they forget what the insurer is really about: MAKING MONEY.

It has very little to do with the particular claimant as opposed to the economic model under when this system operates. For this reason, we are fond of saying: “It is not what is black and white, rather than what is green.” Or, in Watergate terms: “Follow the money.”

The insurance company cares little or nothing about the actual substance of your case. They need to deny as many cases as possible so as to reduce their losses. You just need to look at the business model for disability insurers. They collect premiums and make money on the float (period of time from the time premiums are paid until benefits will become payable) and from claims that are eventually denied.

If you take the time to read the actual formulaic claim denial, it sets forth a recitation of several plan provisions, followed by a selective recitation of the medical evidence, then comes the findings of their hired gun reviewer/examiner, then culminating in the findings that disability benefits are not payable.

Although your disability claim may seem very well supported in terms of having medical reports reciting your diagnoses and, perhaps, a finding that you are not able to work, this is clearly insufficient to prove your case to an insurer.

The insurance company is hoping for one of three courses of action for you to take: (1) getting defeated and giving up the claim; (2) filing your own insufficient appeal; or (3) seeking representation from your local attorney who says that he/she “will see what they can do” despite having little experience in such cases. Each and every one of these course of action can be fatal to your claim.

This is where we come in.

Our appeals commonly run a hundred pages in length with many medical, legal, functional capacity, and vocational arguments which are backed by thousands of pages of exhibits backing the medicine and demonstrating the bad past behavior of the insurer in question.

The information created and held by this firm is not available to the public. The internet will not save you despite how many articles you download. Further, these article never tell you how to appeal your case successfully to a particular insurer. Each insurer has its own variation on the “denial formula” which must be responded to in kind.

Therefore, the first thing you do when faced with a claim denial is call an experienced attorney. If you appeal the case and include a few more medical records and a couple letters with no more, you will ultimately be unsuccessful and may not be able to put more in the administrative record. For insurers who only have a single appeal system, you have just lost your case.

And, don’t for a minute, believe that the all-too-helpful insurance representative only is dying for you to follow the advice to file your own appeal without getting an attorney. They live for this moment. Don’t do it. You will be very sorry as there may be no means of rescuing your case thereafter.

Posted in General Disability Issues | Tagged , , , , |


Understanding the Disability Insurance Model

In essence, insurers sell “paper,” a promise to pay in the future in exchange for cash now. Insurance is designed to protect against risk, because individuals who buy insurance are financially compensated in case of loss. For protection against loss, individuals pay insurance companies for specific types of risk. Individuals pay premiums to an insurer as part of an insurance contract in exchange for transferring the risk of loss to a large group of individuals who then share the financial loss.

Disability insurance is designed for income replacement for all or part of a person’s income if he or she becomes unable to work or can only earn a reduced income as a result of disability. Group disability coverage includes high and law risk people grouped together in the plan.

The underwriting for disability policies tends to be substandard to that of life policies as it involves consideration of many physical conditions and impairments which can result in long term disability. Many of these conditions and impairments will not affect a person’s life span and play no role in life insurance underwriting. This is made even worse by a lack of claims experience studies on disability risk. Underlying this is the subjective nature of disability claims which makes such studies difficult to undertake. Even underwriting manuals only set forth suggestions actions for impairment risks rather than objective and precise standards. Therefore, disability underwriting remains more of an art than a science.

Exclusion riders represent a negative approach to underwriting and an “admission of defeat” of sorts. Rather than determine the risk of impairment, the underwriter chooses to exclude the particular impairment in its entirety. Since it is difficult to exclude entire impairments, many underwriters choose to implement limited exclusion riders in which reduce certain impairment benefit periods.

The most significant responsibility of underwriters is to determine premium that factors in the likelihood of a claim and enables the insurer to earn a profit. http://www.ftpress.com/articles.aspx?p=19038886&seqNum=2) Premium rates are also determined in response to insurer losses.

Occupation in disability claims plays a critical role, especially its physical requirements. It is far more common for a physical laborer who must use his body to become disabled and for a longer period than a professional worker who mostly undertakes mental work. In general, education and income result in more favorable morbidity. Consequently, lower premiums are offered for white collar workers. With less physical labor being undertaken in the workplace, underwriting has gone toward evaluation of stability, motivation, and responsibility in one occupation as opposed to another.

Group disability policies can be marketed quite profitably at a relatively lower cost in comparison with individual contracts. These contracts are generally more restrictive and can be price adjusted as needed. Group contracts tend to have more limited benefit pay periods and will make deduction for other benefits received. Minimal underwriting is required. An insurance company may need to match other companies’ offers which include enhanced coverage or lower pricing in order to prevent losing market share.

The claims processing function determines the cost of a loss and pays the claims to the insured. http://www.ftpress.com/articles.aspx?p=19038886&seqNum=2)Claims handling requires a greater level of expense, activity and training than a life insurance claims examiner possesses. The training and position responsibilities of a disability claims examiner rivals that of an underwriter. As many disability claims examiners are required to perform necessary review, this requires an efficient, accurate and responsive administrative and examination process. The contract language and will only resolve some potential problems, where the claims examiner must rely on his experience and professional judgement to resolve most others.

The specific procedures to be utilized for claims review should be spelled out in the disability insurance contract. Problem claims such as those involving younger individuals with higher earnings can cost the insurer large sums of money of the course of a period of disability. For this reason, claims department must have training procedures and claims guidelines for its examiners which include lay medicine, claim investigation, field handling, etc. Claims investigation is of paramount importance and include weighing factors such as the age and occupation of the claimant, severity of the disability, subjectivity of the disability, and projected length of disability. Medical examinations are not routinely requested, but are reserved for disability claims of potentially long duration and degree of recovery is in question.

Insurance companies make money in two ways: from investments and by generating underwriting profit (collecting premiums that exceed insured losses and related expenses). Money is made by investing assets set aside for claims during the interval period between receiving the premium and payment of claims, known as “the float” (also known as the “reserves”). The float, in turn, becomes an important source of investment income.http://www.ftpress.com/articles.aspx?p=19038886&seqNum=2)

Insurance can lose money on their investments or on the insurance contracts they have written. These losses can stem from investment (losses from float (reserve) money investments), claims losses (claims paid are greater than premiums received due to mispricing insurance by underestimating the risk). Incorrect calculation of risks can turn the insurance business ugly. For example, investment in subprime mortgage-backed securities during the financial crisis of 2008 caused large losses.http://www.ftpress.com/articles.aspx?p=19038886&seqNum=2) http://www.ftpress.com/articles.aspx?p=19038886&seqNum=2)

There have been many instances of improper conduct resulting in insurer insolvency:

  • On September 16, 2008, the American International Group (AIG) received an $85M initial bailout payment from the U.S. Government before it became insolvent. This amount eventually was increased to $150B. In exchange, the Government received nearly 80% of AIG’s equity. The near insolvency resulted from bad investments in collateralized debt obligations (CDOs) comprised of tranches of subprime mortgage loans in addition to accounting problems. AIG faced an $11B shortfall to cover potential claims in 2009 while it paid $218M in executive bonus pay following posting a $61.7B loss in 2008.
  • The Mission Insurance Company was hit with $1.5B in losses when it only held $240M in capital surplus. Much of this deficit resulted from increasing workers compensation and automobile insurance business through deep discounting of premiums. When it was first investigated, the company had a $169M reserve deficiency and $900M in unpaid claims. It was liquidated in 1987.
  • The Transit Casualty Company racked up $4B in losses with its liquidation taking until 2012 to complete. It began as a small company with a manual claims processing system which grew rapidly, growing from 800 to 37,000 policies sold during 1982 – 1983 without underwriting guidelines. For example, it issued an 18 state Wal-Mart policy for half the reasonable cost of such coverage with a guaranteed no increase in rate charged.   It was ordered to stop writing policies by 1985 and quickly went into liquidation with investigation finding swapping of policies by a multitude of different insurance and resinsurance companies while not paying 200,000 claims
  • The Integrity Insurance Company was started in 1957 and provided insurance for banking loan collateral and principals taking loans. In the late 1970’s, it diversified into many coverage areas including commercial property and casualty, umbrella policies, hospital professional liability, personal and commercial automobile, commercial fire, inland marine, commercial special multiperil, geneal liability, and others while passing the risk of to reinsurers and retaining as little as 1% of coverage in exchange for commissions for policy sales. It was placed into liquidation in 1987 with $1B in losses and $2B in unpaid claims
  • The Maryland Indemnity Insurance Company collapsed in 1977 after creating a vast network of national and international companies writing insurance for medical malpractice in addition to liability insurance for various purposes including nurses, hearing aid installers, lounge owners, trucker, underground storage tanks, guides and outfitters, marine hull coverage, among others. It had no reinsurance protection while holding a potential claims liability of $50M. When it shut down, the company had just over $2M in assets and nearly $6M in liabilities.

Economy Effects

Economic recessions and unemployment tend to cause in increase in disability claims frequency and move in direct proportion to the severity of the recession. It is at such times, that claims examiners must be aware of the potential for claims abuse due to malingering and increase their investigative efforts. This presents increased problems for the claims examiner in the degree of length of disability in claims involving subjective factors and understanding that these factors themselves may be escalated in time of economic recession.

Insurance companies owned by stockholders have to answer to stockholders. If management’s investment strategy are carried out with shareholder expectations, seizing opportunities for growth and profit, then they may be acting at the expense of policyholders. Unfortunately, no ownership structure is a cure-all for poorly conceived or executed strategies.

The combined factors of the aging “Baby Boomers” (who have reached their peak of disability) along with a slumping economy have resulted in rising disability claims. Aged persons (over 50) with impairments have difficulty finding work. Even seasoned workers will be dropped if they cannot maintain a production rate for 40 to 50 hours per week. Older workers staying on the job often spend time at work on non-work responsibilities. Many employers choose to “do more with less” and seek to have older workers make disability claims in order to reduce the financial burden to the employer.

The effect on increased disability claims in insurers has been immediate. For example, Lincoln Financial experienced an 8.8% first quarter loss in 2015 as a result of increased long term disability claims.

When insurance companies issue policies, they are required to have undertaken proper underwriting in order to retain sufficient reserves to pay claims as they come due.

When insurance companies market policies in multiple areas to gain market share through underpriced offerings, often with insufficient underwriting and/or retention of capital reserves or sufficient reinsurance, they will eventually suffer losses. When premiums fall short and are insufficient to pay incoming claims, claims are denied. At this point, the claims department becomes the only area where an insurer can exercise loss control.

With the rapidly increasing number of disability claims stemming from an aging workforce, particularly from larger and cheaper group policies issued, insurers are forced to deny claims in order to prevent greater losses. This is made worse when insurers face investment losses due to poorly chosen stock market, real estate, or foreign investments.

For this reason, claims departments are subject to economic pressures which have bear consequence of payment of claims rather than determining payment in accordance with policy terms alone as required and expected from their insureds.

Posted in Economics, General Disability Issues | Tagged , , , |


Lyme Disease Is the New Fibromyalgia

Twenty years ago, fibromyalgia was the single most controversial diagnosis in disability cases. The disability insurers would routinely dispute whether it constituted a real “illness.” They went so far to recruit any doctors which would write that the constellation of symptoms experienced by claimants were little more than physical manifestations stemming from psychological disturbance. An in-house medical director at Unum pejoratively called fibromyalgia “Burn Out Syndrome.”

Eventually, fibromyalgia became an increasingly accepted diagnosis, partially as a result of the number of medical providers who supported the diagnosis and backing research. I attribute the main reason for the acceptance of the fibromyalgia to another source: mass media advertising. Pfizer introduced its drug Lyrica by bombarding the television airwaves with it advertisements saying over and over that: “Fibromyalgia is a real illness.” If you did not see the television ads, then there were the print ads. No matter what, fibromyalgia was now established as “real” over and over again in the consumer’s mind including those of the judiciary.

Of course, this does not stymie the disability insurers who have now using the same fibromyalgia playbook to address Lyme disease. The insurers are very quick to have their retained medical reviewers state that Lyme disease is a controversial diagnosis and note that the findings including positive serologic/genetic tests are not proof positive that the disease is present. As with fibromyalgia, these biased medical reviewers are careful to avoid the clinical aspects of the diagnosis. They make no effort to explain why the claimant suffers from the same, consistent assortment of symptoms. They just contest the diagnosis in order to try to negate the associated disability in spite of mounting medical literature which supports that presence of the disorder.

Unfortunately, unlike fibromyalgia, there is no mass-marketed, branded medication which ameliorate its symptoms which is available from the drug manufacturers. So, there are no educational campaigns bombarding the airwaves stating that Lyme disease is a “real” illness.

This firm prides itself on its efforts to educate the judiciary concerning the realities of Lyme disease by presenting updated medical literature acquired from the National Library of Medicine in Bethesda, Maryland, this nation’s largest medical library. This more informed approach attacks the insurer’s hired guns and demonstrates that the contrary medical reviews issued have no basis in medical fact and are only the product of testimony for compensation. It is not lost on them that Scott Elkind has a bachelors degree in biology and a Masters in forensic sciences, a scientific and medical background few lawyers possess. Their claims personnel and lawyers cannot match this acumen in defending their corrupt economically-driven positions favoring denial of Lyme disease disability claims.

Posted in Benefits, Disease | Tagged , , |


Social Security Employee Conduct and Repercussions

The Office of the Inspector General for the Social Security Administration (SSA) issued its Audit Report dated November, 2015, entitled “Social Security Administration Employees with Conduct Issues Who Received Monetary Awards.” At first glance, all I could think was: “Huh?” So, I just had to read it to believe it.

As it turns out, SSA paid approximately $145K to 240 employees who had been disciplined for conduct issues ranging from discourteous conduct, unauthorized access to SSA records, failure to follow SSA procedures, and misuse of government credit cards and resulting in reprimands, suspensions, and demotions.

In general, SSA policy rewards employees with awards who are in “good standing.” Unfortunately, SSA defines “good standing” as receiving a performance rating evaluation of “performing successfully” and not based on any history of misconduct. Further, many awards are discretionary in nature (read “mandatory” under union-negotiated contract) and must be awarded to reprimanded employees or result in violation of union agreement.

Following review of this situation and issuing a comprehensive report, the Inspector General came to the conclusion that SSA “should consider revising its policy to limit management officials’ discretion to grant awards to employees with conduct problems” and create a database to track employee disciplinary history with awards policies.

Nothing like taking quick and decisive action over an obvious situation in need of address. This is our government at its finest.

Posted in Social Security, Social Security Administration, SSA | Tagged , , |


Social Security Reporting (4/1/15 – 9/30/15)

The Office of the Inspector General for the Social Security Administration (SSA) issued for the period of April 1, 2015 to September 30, 2015 report in which it made the following statements:

  • There have been $374M in questioned costs during this period
  • Updated its estimate that SSA has made $16.8B in overpayments and had only recovered $8.1B, was in the process of recovering $6.3B, and waived or canceled $2.4B
  • SSA had spent $231M more to recover low dollar overpayments than it could collect
  • SSA failed to identify deceased beneficiaries from its own Medicare usage data
  • 80,598 allegations were received by SSA employees, Congress, the public, law enforcement agencies, and other sources resulting in 4,290 criminal investigations culminating in 168 arrests, 552 indictments, 623 criminal convictions, and 195 civil judgments contributing to more than $270.4M in projected savings (although the cost of the program was not disclosed)
  • Concerns for the representative payee program were expressed as a result of the expected growth in the aged population experiencing dementia
  • Expansion of the fraud prevention units to more cities with 36 such units now operating
  • After increasing the number of administrative law judges in from FY 2010 – 2013 by 18%, there was as decrease in FY 2014 with expected hiring of 200 more ALJs in 2015 while losing another 100 due to attrition
  • 86% of Disability Determination Service offices have unacceptably long processing times
Posted in Social Security | Tagged , |


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