(CNSNews.com) – “We keep putting people on disability who are not truly disabled,” said Sen. Tom Coburn (R-Okla.) on Tuesday at a House Oversight and Government Reform Committee hearing entitled, Social Security Administration Oversight: Examining the Integrity of the Disability Determination Appeals Process.
Coburn, who also is a medical doctor, was called to testify about disability-payment reform for the House-held hearing.
“Currently, 8.4 million people are enrolled in SSI [Supplemental Security Income for the disabled], at a cost to the federal government of nearly $56.5 billion in 2013,” according to a June 10 Oversight Committee report. “The number of participants in SSI has nearly doubled over the last 25 years. Growth in SSI enrollment also increases Medicaid spending since individuals enrolled in SSI are automatically eligible for Medicaid.”
“Most of us know that the Social Security disability trust fund is in precarious shape,” Senator Coburn told the committee. “11 million Americans who presently are in need of those payments will receive a cut.”
Coburn, along with Sen. Carl Levin (D-Mich.), reviewed random disability cases from Social Security from three different offices.
“What we found is alarming,” Coburn said. “What we found is 25% of the cases should never have been approved by benefits based on Social Security’s own rules and procedures. So, we had 25% where their own administrating law agents didn’t follow their own rules.”
A disability fraud case in Huntington, West Virginia, evoked concern for Coburn. “This got our attention because this office processed more disability cases than any other office in the nation,” he said. “And so when we looked at it, much of that could be accounted to one attorney, Eric C. Conn.”
“In spite of practicing in a town of 500 people, he had become the third highest payment Social Security receiving over $4 million dollars in agency fees in 2010,” said Coburn. “When we looked more closely at Mr. Conn’s operation, we found reasons for serious concern. Some of what Mr. Conn did was outright fraud. At times he was simply able to exploit loopholes in the program. Both of those should be a concern for us in Congress, given the current nature of the trust fund.”
“Something has to change in terms of the enforcement of our laws and the rule of law if, in fact, we’re going to change the Social Security system,” Coburn said. “We keep putting people on disability who are not truly disabled and you send a postcard saying, ‘Are you still disabled?’ They are going to answer, yes. So it’s not going to do anything. So I agree that we should fund it but we need major changes.”
According to the Oversight Committee Report, when an individual applies for disability benefits, initially their case is examined by a State Disability Determination Service (DDS) office. If they are denied benefits after this, in most states, they can appeal to a different reviewer in the same office. If their case is denied again, then they can appeal to a Social Security Administrative Law Judge, otherwise known as an ALJ.
“Remember when someone comes to an ALJ, they’ve been turned down twice by people very knowledgeable in the system,” said Senator Coburn. “Two separate Social Security employees that look at either the grid or the medical history, looked at the long requirements and had said no. The key thing we need is that input since the judges routinely won’t read their input into the trial hearing, into the disability determination.”
“Once individuals are enrolled in a federal disability program, they almost never go back to work. Less than one percent of those who were on SSDI at the beginning of 2011 have returned to the workforce,” the Oversight Committee report stated. “Instead of managing a meaningful Federal adjudication program, SSA management has substituted a factory-type production process.”
“Judging is not a factory work process, but SSA has taken that approach for speed and high volume results,” reads the report. “As a result, SSA management can present to Congress and the American people with some impressive production statistics, but these statistics have been achieved by causing incalculable damage to the adjudication process at SSA.”
The report continued, “For a variety of reasons, ALJs have a greater incentive to award benefits than to deny benefits. First, ALJs have historically been subject to greater agency scrutiny when they deny benefits, since denials are often appealed and approvals of benefits are never appealed. Second, SSA OIG has found that since ALJs are required to fully document denial decisions, they are usually longer than approval decisions. According to ALJ Zahm, ‘because not as much rationale is needed, because the cases are not appealed, because the decision is quick, because the drafting of the decision is quick, it’s just a whole lot easier [to issue approvals than denials].’”
“Although a case only reaches an ALJ after it has been denied (often twice), hundreds of ALJs routinely allowed more than 80 percent of DDS denials, with more than 100 ALJs routinely allowing more than 90 percent of DDS denials each year over the last decade,” reads the report. “During a transcribed interview with the Committee, Jasper Bede, a Regional Chief Administrative Law Judge (RCALJ) for the agency, testified that when ALJs have a high allowance rate, which he defined as over ‘75 or 80 percent,’ ‘it raises a red flag’ about the quality of their decisions.”
An ALJ who testified at the hearing claimed that he had never seen a case returned by the Appeals who was not disabled.“Having heard thousands of disability cases, I have never had any case returned by the Appeals Council because the claimant was not disabled,” said Gerald Krafsur, an Administrative Law Judge of Kingsport, Tennessee.