After examining the Social Security Administration's (SSA) fraud prevention procedures, the Government Accountability Office released a report concluding that the agency still remains vulnerable to physician-assisted fraud.
The GAO looked at two things-- how Social Security policies are designed and implemented to prevent physician-assisted fraud and the steps the agency is taking to improve its ability to prevent fraud.
What they found were possible disincentives to identify and report fraud. Because the agency incentivizes processing claims as quickly as possible, GAO concluded SSA staff may be reluctant to report potential fraud.
Some staff told GAO they were reluctant to report potential fraud due to a "perceived lack of communication from the inspector general regarding the status or outcome of their fraud referrals."
Other staff, from four of the five disability determination services the GAO visited, said they lacked adequate anti-fraud training.
"While the full extent and nature of physician-assisted fraud is difficult to measure, each fraudulent claim allowed by SSA has the potential to cost the government several hundred thousand dollars over the life of the claimant and places an additional financial burden on these programs at a time when SSA estimates that its disability trust fund will be depleted and unable to pay full benefits to individuals starting in 2016," the report stated.
"Any occurrence has the potential to undermine confidence in SSA's ability to award benefits only to deserving individuals," it added. "The agency relies on front-line workers, including those who collect and assess claimants' medical records at DDS offices, to be the first line of defense against potential fraud.
"They are also expected to make timely and accurate disability determinations. In some instances, the agency's focus on making determinations quickly has been a disincentive to reporting suspicious physicians or potential fraud. Unless SSA and the DDSs work to remedy performance measures that primarily focus on and reward timeliness, possibly at the expense of delving into potentially problematic claims, the agency will remain vulnerable to potential fraud. Further, absent enhanced and consistent training, front-line staff may lack the expertise to identify and report potential fraud."
For the 2015 fiscal year, SSA is expected to exceed $200 billion, according to the report.
The report was conducted from July 2013 to November 2014, and was requested by Sen. Orrin Hatch, R-Utah and Rep. Sam Johnson, R-Texas.
"Physician-assisted fraud is a serious problem, and as the GAO points out, Social Security's current response has been woefully insufficient and inadequate," Hatch said to The Hill. "The disability trust fund is depleting at a rapid rate, and each instance of fraud strains scarce resources needed for the truly disabled.
"The Social Security Administration has a duty to the American people to ensure that disability benefits go to deserving Americans and that tax dollars received from hard-working American taxpayers are not wasted or stolen."
To fix the problem of using misguided medical evidence provided by unscrupulous doctors, Johnson is pushing a bill called the Stop Disability Fraud Act, which would prevent Social Security from using medical evidence submitted by "dirty doctors."
