From USA Today:
“Want to know how the federal
government grants disability benefits? It'll cost you.”
The Social Security
Administration is best known for running the nation's largest retirement
program. But it's also responsible for deciding whether millions of Americans
qualify for disability benefits. If you want to understand how those decisions
are made, it's going to cost you – $2.3 million. That was the administration's
response to a USA TODAY Network request for public information. Reporters are
trying to scrutinize the performance of doctors hired in each state to review
federal disability applications, including their workload and how fast they
reviewed application files. The agency's extraordinary price tag indicates that
Social Security has no central database, but rather allows each state to manage
doctors differently – a policy that, in at least one state, led to an unusually
high denial rate and hefty doctor paychecks. Alan Chrisman holds medical bills and records
near the McDonald's where he worked at as a maintenance employee before being
diagnosed with stage 4 colorectal cancer. This photo has been altered to blur
the address on the envelope. In Tennessee, a network investigation revealed
that some doctors were racing through claims. Paid by the case, doctors were
reviewing up to five files per hour. Experts say such a pace is implausible.
The federal standard for so-called medical consultants is 1.5 cases per hour.
Lawmakers in Tennessee have called for an investigation. The $12.4 billion
Social Security Disability program has to protect public funds from fraud, so
the high case loads and understaffing lead reviewers to err on the side of
denial. Legal advocates say these doctors are being incentivized to speed
through cases to maximize their pay. In the process, they're wrongly denying
applicants who have legitimate claims. One doctor, for instance, failed to
obtain a hospital discharge paper that showed a Tennessee patient's colorectal
cancer was inoperable and had metastasized. The prognosis would have clearly
qualified Alan Chrisman for disability, even under the complex rules set by the
Social Security Administration. Chrisman, 59, hired a lawyer, appealed his
denial, and a different doctor recommended him for disability. Application
files can stretch to hundreds or thousands of pages, with doctors' notes, lab
results, hospital reports and work histories. The Social Security-hired doctor's
opinion weighs heavily in whether someone will be approved for cash assistance,
or denied. On average, state reviewers denied 65% of disability claims in
fiscal 2018. Some states – including
Tennessee, Arizona and Mississippi – had
higher rates, rejecting more than 70%. Alan Chrisman was diagnosed with stage 4
colorectal cancer over a year ago. He applied for disability but was denied
based on a recommendation by a medical contractor hired by the state to review
claims. He then found a lawyer to file a request for reconsideration. Another
physician examined his file and recommended he be granted disability. "A
medical consultant's determination kicks off the whole thing," said
Jennifer Burdick, an attorney with Community Legal Services of Philadelphia. "If
a medical consultant gets it wrong, an individual can go without medical care,
housing or income for years. There needs to be a way to police against
that." Ashley Palma, an attorney based in Norwich, Connecticut, said she
routinely represents clients who were wrongfully denied benefits. Some of her
clients have become homeless or died after being rejected, unable to work or
afford health care. A denial can be appealed, but there is a backlog of 720,000
people waiting for their cases to be heard. "The fact is no one is really looking
into what is happening on a large scale," she said.
A lack of centralized data
In October, the USA TODAY Network
submitted a Freedom of Information Act request seeking doctor performance data
for each state. The agency responded in
April, indicating they would need 72,100 hours to get such information. That’s
the equivalent of nearly 60 employees working full-time on the request for a
full year – without taking vacation or holidays off. States reported
dramatically different estimates. Officials in Iowa reported that getting the
records would take 9,063 hours. Even then, the data wouldn’t include the amount
of money each reviewing doctor made, or how long they took to review each case.
Colorado, meanwhile, reported the request could be fulfilled with 20 hours.
Maine officials reported the data could be delivered in eight hours. "The
data varies from state to state," a letter from the administration said. The lack of centralized information raises
questions about how the administration can ensure disability claims are being
reviewed carefully, or whether the agency's budget is based on accurate case
loads. "The data is there. It's sitting in each state office," said
Dr. John Mather, former chief medical doctor for disability programs at the
Social Security Administration. "They have to have that data to make
budget calculations. They just don't want you to know." Mather retired to
Tennessee, where he worked as a contract doctor until he was fired in 2017
after raising concerns about the high volume of cases reviewed by some doctors.
On Wednesday, the Social Security Administration declined to respond to
additional questions about its oversight of disability programs. Instead it
closed the USA TODAY Network's public records request entirely. "Because
we have not received payment, we are closing your request," an email from
an agency spokeswoman said.
Network investigation introduced
as evidence in dozens of appeals
In Tennessee, more than a dozen
attorneys have introduced the network investigation's finding as evidence in
appeal hearings for clients who claim they were wrongfully denied. Judges have
been receptive, said Chris George, a Gallatin-based attorney. George provided a
transcript of a recent hearing in which he introduced the data but declined to
name the specific judge, saying he did not want to get the person in trouble
with the Social Security Administration. "Let me state on the record, my
decision is going to be made on my assessment of the medical evidence, not on
Dr. Thrush's five or ten minute assessment, I'll guarantee you that," the
judge said after George asked to introduce data. Thrush is a Tennessee doctor
who reviewed, on average, a disability case every 12 minutes over a five year
period. He is the doctor who recommended against cancer patient Alan Chrisman's
disability. "I'm not going to be a party to any kind of fraud that the state
DDS (Disability Determination Services) is sponsoring with Thomas Thrush,"
the judge said. The Social Security Administration denied a reporter's request
to attend a disability hearing, despite having permission from the applicant
and administrative law judges.
^ I know for a fact that the
Social Security Administration, despite being a Federal Government-run
Department – differs greatly depending on the state you currently live in. When
I lived in Virginia I helped a family member through the process of applying
for Social Security Disability benefits. This relative was going from making
several hundreds of thousands of Dollars a year to a couple of thousand a month
– not what you would call someone trying to “abuse” the system and make money
off of it. This relative had no choice but to apply for Disability Benefits
(because they were too ill and disabled to continue working.) The SSA in
Virginia tried at every step to prolong the process. They wouldn’t talk to me
despite my having a Power of Attorney because my relative had difficulty speaking.
They kept “losing” documents even when I personally went to the local SSA
office and hand-delivered them. They wasted over a year. I know the majority of
Disability claims with the SSA are denied out-right and you then have a long
struggle to appeal the decision, but what I am talking about is waiting over 1
year without a decision even being made. The only way we “fixed” the issue was
moving out of Virginia and to our current state. We went to our new SSA office
to try and get some answers (and brought all our documentation, etc.) I was in
the waiting room with the SSA receptionist spoke to her counterpart in
Virginia - since our claim had started
in Virginia my new state needed Virginia to simply electronically transfer the
case to them. I heard the receptionist shouting at the VA SSA office: “All you
have to do is double-click on the screen and it will automatically transfer to
us and you will be done with this claim.” After a long time on the phone the
receptionist hung up and told us that everything was now in their control. They
would have to review the claim (they took all the documentation we had with us
just in case it wasn’t online from Virginia.) A week later my relative not only
was granted Disability Benefits from the SSA, but also got back benefits from
when we first applied in Virginia. That proved to us that the SSA and how
Disability Claims are handled varies greatly between states – when it should be
uniformed since it is Federally-run. Had we not moved out of Virginia we would
probably still be fighting with the SSA there. It is a disgrace how the Social
Security Administration runs their Disability Claims Section. I understand that
there are people who aren’t really disabled and are trying to “cheat the system”
as people tend to do with many different programs and I believe there should be
checks and balances to weed-out those that are lying, but it is one thing to
have to appeal your Disability Benefit rejection and another to hand-deliver
everything and still have things go “missing” just to prolong the initial application.
There clearly needs to be more checks and balances on the states and their
employees as well as those applying since both groups seem to be “abusing” the
system. ^
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