Posts Tagged With: Tom Coburn

Social Security Judge Found Unconscious But Alive

Under fire retired Social Security Judge recently found unconscious by police 

BARBOURSVILLE, W.Va. — A Barboursville police report released Friday said police recently found a former federal administrative law judge, who has been under investigation, in his car barely breathing after what may have been a suicide attempt.

Retired Social Security Administrative Law Judge David Daugherty has been under fire since a 2011 report.

Various media reports Saturday detailed the police report concerning David Daugherty.  That report said he was found unconscious in his car Monday afternoon in a Barboursville church parking lot.

The report said the police found a garden hose running from the car’s exhaust into the passenger side of the vehicle.

Judge Daugherty was taken to a hospital and later released.

Judge Daugherty retired in 2011 shortly after a story in the Wall Street Journal focused on the high rate in which he approved Social Security disability cases. Judge Daugherty was placed on leave after the story broke. Allegations of fraud have been under investigation by a U.S. Senate committee. The committee recently held a congressional hearing.

The fraud is so rampant, and disability cases have so proliferated in recent years, that the Social Security’s Disability Trust Fund may run out of money in only 18 months, says Sen. Tom Coburn, R-Okla., whose office undertook the investigation.

Coburn’s report on widespread fraud focuses in large part on a veritable “disability claim factory” allegedly  run by Attorney Eric C. Conn out of his small office in Stanville, Kentucky, a region of the country where 10 to 15 percent of the population  receives disability payments.

The report documents how Attorney Conn allegedly worked together with Social Security Administrative Law Judge David Daugherty (ALJ)  and a team of favored doctors with checkered pasts, including suspended licenses in other states, who rubber stamped approval of disability claims. In most cases, the claims had been prepared in advance with nearly identical language by staffers in Conn’s law office.

The report found that over the past six years, Attorney Conn allegedly paid five doctors almost $2 million to provide favorable disability opinions for his claimants.

In 2010, the last year for which records are available, Judge Daugherty approved 1375 disability cases prepared by Attorney Conn’s office and denied only 4 of them – an approval  rate that other administrative law judges have described as nearly  impossible.

Judge Daugherty, 75 years old, processed more cases than all but three judges in the U.S. He had a wry view of his less-generous peers. “Some of these judges act like it’s their own damn money we’re giving away,” Mr. Daugherty told a fellow Huntington judge, Algernon Tinsley, who worked in the same office until last year, Mr. Tinsley recalled.

Judge Daugherty was a standout in a judicial system that has lost its way, say numerous current and former judges. Judges say their jobs can be arduous, protecting the sometimes divergent interests of the applicant and the taxpayer.

Some former judges and staff said one reason Judge Daugherty was allowed to continue processing so many cases was because he single-handedly helped the office hit its monthly goals. Staff members can win bonuses and promotions if these goals are surpassed as part of performance reviews.

Critics blame the Social Security Administration, which oversees the disability program, charging that it is more interested in clearing a giant backlog than ensuring deserving candidates get benefits. Under pressure to meet monthly goals, some judges decide cases without a hearing. Some rely on medical testimony provided by the claimant’s attorney.

The report found, “Judge Daugherty telephoned the Conn law firm each month and identified a list of Mr. Conn’s disability claimants to whom the judge planned to award benefits. Judge Daugherty also indicated, for each listed claimant, whether he needed a “physical” or “mental” opinion from a medical professional indicating the claimant was disabled.”

The report says that when Senate staffers and the Social Security Administration’s Office of the Inspector General began an investigation based on tips from whistle blowers, Attorney Conn and Judge Daugherty began communicating with disposable, pre-paid cell phones. It also alleges they contracted with a local shredding company to destroy 13 tons of documents. Attorney Conn also allegedly destroyed all the computer hard drives in his office.

In 2011, the SSA placed Daugherty on administrative leave. He retired shortly after that.

Attorney Conn’s legal fate is now in the hands of the Justice Department.

The alleged  fraud highlights an endemic problem in Social Security disability benefit awards. The Coburn report says a random examination of 300 case files by Congressional staff found more than a quarter of  the case files “failed to properly address insufficient, contradictory, or incomplete evidence,” suggesting a high rate of fraud or abuse.

Daugherty served as a Cabell County circuit judge for 7 years beginning in 1977.

By Jeff Jenkins in News | October 19, 2013

Categories: Social Security Judges | Tags: , , , , , , , , | Leave a comment

Disability Fraud Runs Deep and Wide

Social Security Poster: old man

Social Security Poster: old man (Photo credit: Wikipedia)

Widespread fraud reported in Social Security Administration‘s Disability Program

A two-year investigation by the Senate Permanent Subcommittee on Investigations has found widespread fraud in the Social Security Administration’s (SSA) Disability Program. It appears that disability payments have skyrocketed because the SSA’s  attempt  to reduce the  back-log of disability cases has forced administrative law judges to hold hearings without reviewing the medical evidence in the case files, decide cases without holding hearings, and approve cases of claimants that are not disabled.

The fraud is so rampant, and disability cases have so proliferated in recent years, that the Social Security‘s Disability Trust Fund may run out of money in only 18 months, says Sen. Tom Coburn, R-Okla., whose office undertook the investigation.

Coburn’s report on widespread fraud, released Monday, focuses in large part on a veritable “disability claim factory” allegedly  run by Attorney Eric C. Conn out of his small office in Stanville, Kentucky, a region of the country where 10 to 15 percent of the population  receives disability payments.

(Judge David Daugherty)

The report documents how Attorney Conn allegedly worked together with Social Security Administrative Law Judge David Daugherty (ALJ)  and a team of favored doctors with checkered pasts, including suspended licenses in other states, who rubber stamped approval of disability claims. In most cases, the claims had been prepared in advance with nearly identical language by staffers in Conn’s law office.

The report found that over the past six years, Attorney Conn allegedly paid five doctors almost $2 million to provide favorable disability opinions for his claimants.

In 2010, the last year for which records are available, Judge Daugherty approved 1375 disability cases prepared by Attorney Conn’s office and denied only 4 of them – an approval  rate that other administrative law judges have described as nearly  impossible.

The average disability-benefit approval rate among all administrative judges is about 60% of cases. But there are Daugherty equivalents dotted across the country. In the first half of fiscal 2011, 27 judges awarded benefits 95% of the time, not counting those who heard just a handful of cases. More than 100 awarded benefits to 90% or more of applicants, according to agency statistics.

Judge Daugherty, 75 years old, processed more cases than all but three judges in the U.S. He had a wry view of his less-generous peers. “Some of these judges act like it’s their own damn money we’re giving away,” Mr. Daugherty told a fellow Huntington judge, Algernon Tinsley, who worked in the same office until last year, Mr. Tinsley recalled.

Judge Daugherty was a standout in a judicial system that has lost its way, say numerous current and former judges. Judges say their jobs can be arduous, protecting the sometimes divergent interests of the applicant and the taxpayer.

Some former judges and staff said one reason Judge Daugherty was allowed to continue processing so many cases was because he single-handedly helped the office hit its monthly goals. Staff members can win bonuses and promotions if these goals are surpassed as part of performance reviews.

Critics blame the Social Security Administration, which oversees the disability program, charging that it is more interested in clearing a giant backlog than ensuring deserving candidates get benefits. Under pressure to meet monthly goals, some judges decide cases without a hearing. Some rely on medical testimony provided by the claimant’s attorney.

The report found, “Judge Daugherty telephoned the Conn law firm each month and identified a list of Mr. Conn’s disability claimants to whom the judge planned to award benefits. Judge Daugherty also indicated, for each listed claimant, whether he needed a “physical” or “mental” opinion from a medical professional indicating the claimant was disabled.”

Coburn’s report found that, “over a four-year period from 2006 to 2010, the Social Security Administration paid Mr. Conn over $4.5 million in attorney fees.” And that, “Mr. Conn was the third highest paid disability law firm in the country due to its receipt of over $3.9 million in attorney fees from the Social Security Administration.”

The report says that when Senate staffers and the Social Security Administration’s Office of the Inspector General began an investigation based on tips from whistle blowers, Attorney Conn and Judge Daugherty began communicating with disposable, pre-paid cell phones. It also alleges they contracted with a local shredding company to destroy 13 tons of documents. Attorney Conn also allegedly destroyed all the computer hard drives in his office.

In 2011, the SSA placed Daugherty on administrative leave. He retired shortly after that.

Attorney Conn’s legal fate is now in the hands of the Justice Department.

The alleged  fraud highlights an endemic problem in Social Security disability benefit awards. The Coburn report says a random examination of 300 case files by Congressional staff found more than a quarter of  the case files “failed to properly address insufficient, contradictory, or incomplete evidence,” suggesting a high rate of fraud or abuse.

Disability payments have skyrocketed across the U.S. in recent years. At the end of August 2013, more than 14 million Americans were receiving disability benefits The Social Security Administration has blamed aging baby boomers and the lingering effects of the recession as two causes, but another reason disability payments have skyrocketed appears to be  the SSA’s  attempt  to reduce the  back-log of disability cases has forced judges to hold hearings without reviewing the medical evidence in the case file, decide cases without holding hearings, and approve cases of claimants that are not disabled.

That, in turn , has led to  less scrutiny of individual case files, which can be hundreds of pages long.

Social Security Administration officials acknowledge they are trying to clear a backlog of 730,000 cases. But they say they remain focused on ensuring taxpayer money isn’t wasted. “We have an obligation to the people in need to provide them their benefits if they qualify, but we also have an obligation to the taxpayer not to give benefits to people who don’t qualify,” said the former SSA Commissioner Michael Astrue.

Doug McKelway

By Doug McKelway

LEXINGTON, Ky. (WKYT) An eastern Kentucky attorney at the center of a national disability fraud investigation is breaking his silence. Floyd County attorney Eric Conn says “the truth will be forthcoming” and for others not to be so quick to judge.

A congressional report accuses Conn of scheming with retired administrative law Judge David B. Daugherty to approve more than 1,800 disability cases from 2006 to 2010.

“I have practiced Social Security disability law for twenty years. I have advertised extensively and represented every claimant to the best of my ability,” wrote Conn in a statement sent to WKYT. “When changes in the law occurred, I studied those changes in an effort to better represent the people who put their faith in me. I have served my clients with honor and dignity.”

Before a senate hearing on Monday, October 7, 2013 Conn refused to answer questions, a former worker claimed he called doctors responsible for signing off on the reports “whore doctors” because they didn’t question the information.

Allegations in a more than 160-page report from a U.S. Senate committee include that Conn “used his law practice to exploit key vulnerabilities in a critical federal safety net program and became wealthy in the process, “inappropriate collusion,” and the “collaborated on a scheme that enabled the judge to approve, in assembly-line fashion, hundreds of clients for disability benefits using manufactured medical evidence.”

Attorney Conn – said to be the third highest paid disability lawyer in the country – stood before a senate hearing Monday, October 7, where four witnesses testified against him. He’s accused of perpetrating massive fraud against the Social Security Administration (SSA).

Daugherty is said to have awarded an unusually high number of benefits totaling $ 2.5-billion while Conn would seek out doctors with suspicious credentials.

“He called them whore doctors because you could get them to do what you want and they were cheaper,” said Melina Hicks who worked for Conn.

The report claims these doctors would sign a claimant’s form — paving the way for Judge David Daugherty to award benefits.
One in three of the cases reviewed revealed identical paperwork.

During this time, Conn received $4.5 million in lawyers fees paid by SSA.

Jennifer Griffith and her co-worker Sarah Carver also testified Monday. They processed disability claims in Huntington, West Virginia.

In 2011, they filed a federal lawsuit against Conn and Daugherty under the false claims act which allows whistle blowers to get a portion of money recovered in fraud cases.

“With Judge Dougherty and Eric Conn, what I seen was 100 percent// if you look at that statistic alone, what’s the likelihood that every claimant who walks into your office is disabled,” said Carver who is a senior case technician for the SSA.

In a “60 Minutes” broadcast on Sunday, October 6, CBS News tracked down Conn.
When reporter Steve Kroft asked Conn to talk about his relationship with the former judge and his incredible success in disability court, Conn didn’t elaborate.

“Boy, that’s tempting. Oh, I would love to comment on some of that. But not – I’m really sorry, I don’t think I should right now,” Conn told CBS News.

At Monday’s hearing, he remained even more restrained.
I respectfully assert my constitutional right not to testify here today, sir,” Attorney Conn told committee members.

Judge Daugherty left the hearing before he was called to testify.
More than 11-million Americans receive disability insurance. That’s up 20 percent in the last six years.

Sen. Tom Coburn who spear-headed the investigation says that this case is just one example of widespread abuse.

“Some in congress refuse to acknowledge that the disability programs are broken and in dire need of significant oversight. People who are truly disabled will pay the price of our dithering,” said Sen. Coburn.

Nov. 02, 2013 

HUNTINGTON — An investigation into the Huntington Office of Disability and Adjudication Review was launched after the publication of a Wall Street Journal article in 2011 outlining the relationship between disability lawyer Eric C. Conn and Administrative Law Judge(ALJ) David Daugherty.

Conn ordered a massive destruction of files at his office, according to a report from the Committee on Homeland Security and Governmental Affairs and testimony at a Congressional hearing last month.
ALJ Daugherty, then 75 years old, called Conn’s firm multiple times in the days after the article appeared, but Conn refused to talk to the judge on his law firm’s phone lines, the Congressional report found.
The report states the judge left a message on Conn’s home phone that said:
“OK. There are those of us who know the D.A. There are those of us who know the circuit judge. There are those of us who have an inside track and hear some things. We need to talk. If you don’t want to, it’s your loss. You need to contact me … You need to do it. There are things you need to know. Good-bye.”
After that, the report alleges, ALJ Daugherty and Conn communicated through the use of disposable prepaid cell phones so the calls couldn’t be tracked.
ALJ Daugherty was placed on administrative leave pending investigation and retired in 2011. Judge Charlie Andrus also stepped down as chief justice of the Huntington office, though he continued to serve as a judge until being placed on leave pending an investigation and retiring this year.
ALJ Debra Bice, chief administrative law judge (Chief ALJ) for the entire Office of Disability and Adjudication Review under the Social Security Administration (SSA/ODAR), told a colleague that when she questioned Andrus on ALJ Daugherty, “he couldn’t give an honest assessment of what was going on.”
While Andrus testified before a Senate committee investigating Social Security fraud earlier this month, Conn exercised his 5th Amendment right not to testify on evidence that might incriminate himself.
Despite receiving a federal subpoena, ALJ Daugherty did not show up for the hearing.
Huntington office workers Sarah Carver and Jennifer Griffith gave detailed testimony on the dysfunction of their workplace, and two of Eric Conn’s former employees also testified.
“Those women, the ones who spoke out, they are extremely brave and deserve a lot of credit,” said ALJ Daniel Kemper, a former judge and colleague of ALJ Daugherty in the Huntington office.
Shortly after the Congressional hearings, Barboursville Police, responding to a call of what the department called a possible suicide attempt, found ALJ Daugherty passed out in a car with a garden hose duct-taped to the exhaust pipe and running into the vehicle. An empty bottle of liquor and an empty pill bottle were also found, according to police.
ALJ Daugherty was revived and spent an unknown number of days at an area hospital before being released.
Just how Huntington Administrative Law Judge David “D.B.” Daugherty managed to be one of the most productive Social Security Administration judges in the country in the later years of his career was something of a mystery to his co-workers and fellow judges. ALJ Daugherty, who became an administrative law judge in 1990, was hardly ever in his office and rarely conducted hearings, according to a report issued by the U.S. Senate Committee on Homeland Security and Governmental Affairs last month after it looked into possible abuses in the Huntington Social Security office.
The report and recent Congressional testimony allege ALJ Daugherty abused an initiative by the Social Security Administration urging judges to decide between 500 to 700 cases per year to clear some of the system’s backlog.
Daugherty well exceeded those marks, moving thousands of disability claims per year, almost all of which he approved by simply looking at a file and making a decision while rarely conducting hearings. When those hearings were conducted, it was at a break-neck pace.
When a fellow judge expressed concern over moving cases quickly, Judge Daugherty told him “You’re just going to have to learn what corners to cut,” according to the report.
The document indicates Judge Daugherty engaged in this behavior for years even before the 2007 initiative, and perhaps made himself indispensable because he exceeded numeric goals and helped put the Huntington Office of Disability and Adjudication Review among the most productive offices in the country.
But the volume of cases didn’t match what colleagues observed of the judge’s work ethic.
The report states one administrative law judge in an email called Daugherty “intellectually lazy,” and that was “probably his most obvious trait.”
Another colleague said Daugherty was “A spoiled little boy who became a judge” who “sought the easiest way out” in his work.
The 266-page congressional investigative report, Congressional testimony and media reports allege Daugherty worked with Kentucky disability attorney Eric C. Conn to abuse the Social Security Administration by awarding unearned disability benefits to so many clients that Conn became the third-highest-earning disability attorney in the United States at one point.
The report also reveals that Judge Daugherty approved benefits in thousands of other cases that had no connection to Conn.
Decisions made by Daugherty from 2005 through 2011 to award disability benefits to claimants cost Social Security more than $2.5 billion, according to the report. His 99.7 approval rating over a two-year monitored period was well above the national average of 60 percent.

In 2010, Judge Daugherty was the third-most productive ALJ judge out of 1,500 judges nationwide, deciding 1,411 cases. Of those, 530, or roughly 37 percent, were claimants represented by Conn. Daugherty awarded benefits in 1,410 of the cases. He denied benefits only once.

The report states it was a running joke in the Huntington Office of Disability and Adjudication Review that if someone was looking for Judge Daugherty, “you should not look in his office.”
Various fellow judges and even some office personnel brought it to the attention of management numerous times that Judge Daugherty would sign in, disappear for the day, then return and sign out as if he had worked eight hours. Sometimes he even gave himself extra hours worked. The judges do not receive extra pay for overtime, but can earn extra leave.
The report states that Daugherty’s behavior when it came to time and attendance was “a constant source of tension” in the Huntington office.
One of Daugherty’s critics in that regard was fellow judge ALJ Daniel Kemper.
“It was extremely frustrating,” the now-retired Kemper said in an interview with The Herald-Dispatch recently. “It’s one of the reasons that I left.”
Kemper and Daugherty were sworn in together in 1990, and assigned to the Huntington office. Kemper said he spent three weeks in training with Daugherty, who had previously been a circuit judge in Cabell County from 1977 through 1984.
Kemper and other justices issued complaints to Huntington Office Chief Justice (HOCALJ) Charlie Andrus multiple times over a period of years regarding the attendance and sign-in issues, but Daugherty was never disciplined.
The report states that Andrus tried on several occasions to kick the complaints up to his superiors, who told the justice it was his responsibility to manage such an issue, with one official saying, “I think Judge Andrus wants someone else to do his job.”
Kemper contended in the congressional report that Daugherty was never disciplined because he moved a high volume of cases.
Former fellow judge William Gitlow wrote to a colleague: “We have Judge Daugherty here who scans the master docket each month, pays 90+% of the time and gets out 80 to 100 cases a month. So we make our numbers each month. Without him we would not. Ever.”
Documents also show that in the case of another Huntington judge who only decided about 20 cases per month, HOCALJ Andrus moved quickly to conduct a thorough investigation of alleged time card abuse.
After a Wall Street Journal article about Daugherty’s relationship with Conn was published in May 2011, Kemper, who retired in 2007, said he was floored by statements Daugherty made to local media.
Daugherty said in those interviews that he moved a lot of cases because he loved his job and applied himself to the task of relieving a backlog of cases.
“He was claiming he got all these cases because he was such a hard worker,” Kemper said. “… His contention that he worked so hard could be refuted just by his time and attendance records.”
Kemper said he had no idea where Daugherty went every day.
” … there was nothing I had seen,” Kemper said. “I didn’t go so far as to make an individual effort to follow him around.”
Enter Eric Conn
The committee report indicates that Daugherty didn’t work hard, but fast.
He decided most of his cases “on the record,” meaning he didn’t conduct a hearing with the claimant, but awarded benefits just by looking at the case file.
In relation to Conn, since at least 2006, Daugherty would call the attorney’s office and read off a list of names and Social Security numbers of Conn’s clients who were on the judge’s docket, referred to as the “DB list,” and tell Conn or his office employees what type of medical evidence he needed to approve the case, investigators found.
Conn would then take disability forms that were already filled out to doctors to sign. Conn allegedly paid local physicians he referred to as “whore doctors” anywhere from $300 to $650 per form, according to Congressional testimony and the committee report.
Daugherty would then write favorable decisions for the client, using variations on the same language in nearly every case, the report states. It also said Daugherty would have Conn change the onset date of a condition so that records of previous denials wouldn’t factor in because the judge would be supposedly looking at a new medical diagnosis.
Many of those cases were moved onto Daugherty’s docket by the judge himself, according to the report and testimony. Andrus was bombarded by complaints from other judges and docket clerks that Daugherty was taking cases that hadn’t been assigned yet, or, in some cases, had already been assigned to other judges.
Andrus would promise to discuss the issue with Daugherty, but the judge was never disciplined, according to the report.
Daugherty was questioned about his relationship with Conn as early as 2002, but deflected any criticism back on Andrus, alleging the chief judge had an inappropriate social relationship with the attorney.
Andrus admitted he had met once with Conn for a meal, and had gone to a movie with the attorney. He also said Conn offered him all-expenses-paid trips to Brazil and Russia, which Andrus said he flatly turned down due to conflict-of-interest issues.
At times, Daugherty made some rather striking allegations about his superior.
In replying to questions from a higher judge about his social relationship with Conn, Andrus said “This is exactly what I was talking about when dealing with Judge Daugherty. At least this time he did not accuse me of doing cocaine in my office.”
Daugherty’s hearings
When judge Daugherty did conduct hearings, they were done in assembly-line fashion, according to his fellow judges.
Daugherty would review Conn’s cases in the Huntington office’s Prestonsburg, Ky., satellite office, which was close to Conn’s legal practice.
“I would be with (Daugherty) in Prestonsburg, and you would see Eric Conn bring in these scores of people at one time,” Kemper said. “(Daugherty) would finish 20 cases in the time it took me to do two or three.”
According to the report, Daugherty would conduct hearings in 15-minute increments, while a single hearing for another judge would take 45 minutes to an hour.
But in most of the cases involving Conn’s clients, Daugherty opted for making “on the record” decisions based on case files and negating the need for hearings.
According to the congressional report, Daugherty conducted 80 hearings for 481 of Conn’s clients he approved for benefits in 2006. Those hearings were conducted over a span of four days.
In 2007, Daugherty saw only four of 509 clients he handled for Conn, with all of the hearings conducted in one day. He didn’t conduct hearings for any of Conn’s 429 clients he approved for benefits in 2008. In 2009 and 2010, he saw a total of five of Conn’s 981 clients who were granted benefits. In 2011, before his suspension, Daugherty saw 18 of 366 clients he approved for Conn, all in one day.
In one instance in 2002, Daugherty canceled a Prestonsburg docket of 30 cases and granted all the claimants benefits using the on-the-record method of case review. However, several court employees needed for the hearings had already been scheduled and paid to be at the Prestonsburg office.
That prompted Andrus to send out a memo to the entire Huntington office asking all cancelations be cleared through him. Regional Chief Justice at the time, Judge Frank Cristaudo, who operated out of the Philadelphia office, wrote a memo requesting that Daugherty be officially reprimanded.
To state that 30 hearings were canceled and 30 on-the-record decisions issued to help the agency meet performance goals suggests possible impropriety and flawed decisions,Cristaudo wrote.
Cristaudo had drafted a reprimand and agency leaders met in December 2002 to decide if Daugherty should be disciplined. According to the report, the letter was never sent due to agency concerns regarding judicial independence.
That phrase — “judicial independence” — was one that Andrus would use time and again while being grilled by a U.S. Senate panel last month on why Daugherty was never disciplined.
According to the report, Andrus did note that Conn would frequently cancel hearings if the case wasn’t on Daugherty’s docket.
He said he confronted Conn directly about this, and Conn remarked “Well, it was good while it lasted.”
According to the report, Daugherty continued to move Conn’s cases to his docket until the Wall Street Journal article was published. That’s when Andrus put a strict lockdown on moving cases and even put a stop to a custom schedule the chief judge had designed that made sure Conn’s cases were heard before any others.
Daugherty did not attend a Congressional hearing on SSA fraud despite a subpoena from the federal government.
Daugherty said he explained his absence in an email through his attorney to the committee, but did not reveal its contents to The Herald-Dispatch.

(Fields, Ben; West-Va Hearld-Dispatch)

During the House Ways and Means Subcommittee on Social Security hearing on Thursday January 16th, Rep. Tim Griffin (R- Ark.) raised questions about the disability program’s efficiency and accuracy in the wake of recent high-profile fraud cases.

Social Security Administration Inspector General Patrick O’Carroll and SSA Acting Commissioner Carolyn Colvin testified before the subcommittee about the SSA’s ability to root out fraud and handle employees who are implicated in a scheme.

Colvin testified that 99 percent of disability payments are made correctly. Griffin, however, noted recent disability schemes in New York, Puerto Rico and West Virginia and challenged the accuracy of Colvin’s claim.

That talking point, Griffin said, “needs to be erased” because the nature of fraud makes it impossible to know how rampant abuse of Social Security disability has become.

Griffin also questioned the SSA’s ability to reprimand and fire SSA employees who are investigated or implicated in disability schemes.

“…We all know that in order to fire someone, they do not have to be innocent until proven guilty in a court of law applying (the) beyond a reasonable doubt standard,” Griffin said. “That’s not the standard to fire people.”

O’Carroll said the preference is to place an employee on leave without pay while investigating criminal activities; however, sometimes employees are left in place and monitored in an effort to identify co-conspirators.

Ms. Colvin is running the agency until the White House nominates a commissioner, and the White House has not signaled when it might move on the vacancy.

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Social Security Program Abuses Cited In Senate Committee Report

Social Security Disability Program Abuses Cited In Senate Committee Report

Senator Tom Coburn, (R-Okla.)

A subcommittee headed by ranking minority member Sen. Tom Coburn, R-Okla., reported findings today on improving benefit award decisions for Social Securitydisability programs.Decisions by ALJs in Social Security disability appeals are riddled with errors and signs of sloppy judgment, according to the report from the Senate Homeland Security and Government Affairs subcommittee on investigations.

More than a quarter of the decisions reviewed by the committee were based on insufficient and often contradictory evidence, according to the report, a finding that is consistent with the Social Security Administration‘s own internal reviews.

“In May 2007, Commissioner Michael Astrue told Congress he would end the growing wait time for an ALJ hearing,” Coburn said. “To reduce this wait time the agency encouraged judges, where appropriate, to consider skipping hearings and write decisions ‘on the record.’

“I think you could flip a coin for anybody who came before the Social Security commission for disability and get it right just as often as the ALJs (administrative law judges) do,” Coburn said.

Coburn said he personally reviewed about 100 of the cases, drawn randomly from counties in Virginia, Alabama and Oklahoma. About 75 percent should not have been approved for benefits, Coburn said. The Oklahoma Republican is a practicing physician.

“One judge we encountered in our investigation played a big role in this effort,” Coburn said. “Between 2007 and 2009, ALJ Howard O’Bryan, from the Oklahoma City office, single-handedly decided 5,401 cases — almost all of them on the record and without a hearing. His decision rate was nearly four times faster than the average judge’s.  In terms of cost, Judge Howard O’Bryan alone awarded an estimated $1.62 billion in lifetime benefits to claimants in just three years.

“I was at first astounded that one person could decide 1,800 cases per year – especially since each case is

nearly 500 pages long.  On average, he decided five cases per day, 365 days per year. I soon learned, though, that he could move through them so quickly because the quality of his work left so much to be desired.”

Coburn said the Oklahoma judge cut and pasted electronic images of medical evidence into his findings. There were contradictory opinions and findings in the cases, so much so that the agency asked Judge O’Bryan to improve his decision writing.

“But, instead of reducing his caseload to a manageable level, the agency began shipping him cases from around the nation,” Coburn said. “He told us that at one point he was asked to do 500 cases just from Little Rock, Arkansas — an average judge’s caseload for the an entire year. When he finished those, he was sent cases from Atlanta, Houston, Greenville, Des Moines and Yakima, Washington.

One 87-year-old judge in Oklahoma City, who averaged about 1,800 disability cases per year between 2007 and 2009, approved between 90 and 100 percent of them annually.

Another judge awarded disability benefits after a hearing that lasted only three minutes.

Among the recommendations in the report is that the Social Security Administration have a representative at appeals hearings to ensure evidence indicating a claimant is not disabled is presented.

The subcommittee questioned top ALJs from the Social Security Administration’s disability office during a hearing on 13 September 2012.

(Read the full story in http://www.amazon.com/socialNsecurity-Confessions-Social-Security-Judge/dp/1449569757)

The report was prepared by Republicans on the subcommittee. However, its factual findings are supported by subcommittee chairman Sen. Carl Levin, D-Mich., who did not sign on because of concerns about some of the recommendations, according to a Levin aide.

FINDINGS OF FACT:

A subcommittee headed by ranking minority member Sen. Tom Coburn, R-Okla., reported findings today on improving benefit award decisions for Social Security disability programs.

Based upon its review of the 300 disability case files, the report finds:

•Low Quality Decisions.  The investigation’s review of 300 disability case files found more than a quarter of agency decisions failed to properly address insufficient, contradictory, or incomplete evidence.  This corroborates a 2011 internal review.

• Insufficient and Contradictory Medical Evidence.  In many cases, at the initial and appellate levels of review, the state-based Disability Determination Services examiners and SSA Administrative Law Judges  issued decisions approving disability benefits without citing adequate, objective medical evidence to support the finding or at times without explaining contradictory evidence.

• Poor Hearing Practices.  There were perfunctory hearings lasting less than 10 minutes, misused testimony provided by vocational or medical experts, and a failure to elicit testimony to resolve conflicting information.

• Late Evidence.   Some case files showed disability applicants submitted medical evidence immediately before or on the day of a hearing or after the hearing’s conclusion.

• Inconsistent Use of Consultative Examinations.  In many cases, consultative examinations submitted on behalf of either SSA or a claimant were either summarily dismissed or heavily relied upon, with little to no explanation.

• Misuse of Medical Listings.  In many case files, opinions failed to demonstrate how a claimant met each of the required criteria in the SSA’s Medical Listing of Impairments to qualify under “Step Three” in the application process. Awards at Step Three are determined to be severe enough to qualify an applicant for benefits.

• Reliance on Medical-Vocational Guidelines.  The majority of disability awards reviewed by the Subcommittee  utilized SSA medical-vocational grid rules.  A recent SSA analysis found that benefit awards were made under these grid rules at a rate of 4 to 1, compared to awards made due to a claimant’s meeting a medical listing.  At times, decisions resulted from a claimant’s representative and the Administrative Law Judge negotiating an award of benefits by changing the disability onset date to the claimant’s 50th or 55th birthday.

• Outdated Job List.  Some case files showed examiners and ALJs relied on the Department of Labor’s outdated Dictionary of Occupational Titles, to identify jobs open to claimants with limited disabilities.  The last major  revision to the DOT occurred in 1977.

RECOMMENDATIONS:

The report makes the following recommendations:

• Require Government Representative at Administrative Law Judge Hearings. Including a government representative at the ALJ Level is a recommendation of the Association of Administrative Law Judges and the Social Security Advisory Board. Congress should designate funds for such a program.

• Strengthen Quality Review Process.  The review process initiated by the Quality Division of the Office of Appellate Operations should be expanded and strengthened by conducting more reviews and developing metrics to measure the quality of disability decisions, and the information made available to Congress.

• Close the Evidentiary Record. To eliminate confusion, inefficiencies, and abuses, the evidentiary record should close one week prior to a hearing, with exceptions allowed only for significant new evidence.

• Strengthen Use of Medical Listings.  Provide additional training to ALJs on the use of SSA Medical Listings, and direct ALJ decisions to identify how a claimant meets each required element of a listing, citing objective medical evidence.

• Expedite Updated Job List.  Move more quickly to ensure the Occupational Information System can serve as a usable replacement for the Dictionary of Occupational Titles to identify jobs that claimants with limited disabilities can perform in the national economy.

• Focused Training for ALJs.  The Office of Appellate Operations, Quality Division, should provide training to all ALJs regarding adequate articulation in opinions of determinations that involve obesity and drug and alcohol abuse.

• Strengthen Consultative Examinations.  Because many disability claimants do not have sufficient funds to obtain detailed medical evidence of their conditions, SSA should determine how to improve the usefulness of agency-funded Consultative Examinations, including requiring an explanation of any significant disparity.

• Reform the Medical-Vocational Guidelines.  The medical-vocational guidelines should be reviewed to determine if reforms are needed.

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Social Security Judges Are “Paying-Down” The Back Log.

Seal of the United States Social Security Admi...

Seal of the United States Social Security Administration. It appears on Social Security cards. (Photo credit: Wikipedia)

The below Atlanta Journal-Constitution article of 13 Sept 2012 reminds one of the police chief’s statement in the movie ‘Casablanca’. “Frankly, Rick, I am surprised to find there is gambling in this club. Are those my winnings?”

Report: Social Security lax on disability claims

WASHINGTON —Social Security is so overwhelmed by disability claims that some officials are awarding benefits without adequately reviewing applications, potentially adding to the program’s financial problems as it edges closer to the brink of insolvency, congressional investigators say in a new report.

In more than a quarter of the 300 cases reviewed by congressional staff, decisions to award benefits “failed to properly address insufficient, contradictory or incomplete evidence.” In many cases, officials approved disability benefits without citing adequate medical evidence or without explaining the medical basis for the decision, according to the report by the Republican staff of the Senate Permanent Subcommittee on Investigations.

In some cases, it appeared that administrative law judges (ALJ) struggling to reduce backlogs didn’t take the time to review all the evidence, the report said. The judges are expected to rule on at least 500 cases a year, with one judge deciding an average of 1,800 cases a year for three straight years, the report said.

“The administrative law judges are not looking at the cases because the pressure from Social Security is to get the cases out,” said Sen. Tom Coburn of Oklahoma, the top Republican on the subcommittee. “I think you could flip a coin for anybody that came before the Social Security commission for disability and get it right just as often as the (judges) do.”

Social Security has been working for years to reduce a huge backlog of disability claims.

“We share the subcommittee’s concern that a small number of judges have failed our expectations with regard to a balanced application of the law, proper documentation, proper hearings and proper judicial conduct,” said Social Security spokesman Mark Hinkle. “We have undertaken a vigorous set of quality initiatives since the time most of these cases were filed about five years ago and data indicates that we have made substantial progress.”

Hinkle added, “We recognize the need for further improvement and are working hard toward that goal.”

At a subcommittee hearing Thursday, Chief Administrative Law Judge Debra Bice said the Social Security Administration has raised hiring standards for judges in the past several years. She said the agency doesn’t hesitate to hold judges accountable, where the law permits. But, Bice said, the law limits the agency’s authority over judges to ensure that they are impartial in deciding cases.

Disability claims typically increase in a bad economy because many people who worked despite their disabilities get laid off and apply for benefits. The recent recession was no exception, with a flood of applications straining the disability program’s already troubled finances.

Without congressional action, Social Security’s disability trust fund will run out of money in 2016, leaving the program unable to pay full benefits, according to the trustees who oversee the program. The trustees have urged Congress to shore up the disability system by reallocating money from the retirement program, just as lawmakers did in 1994. That fix, however, would further weaken the retirement system, which has its own long-term financial problems.

About 11 million people receive disability benefits from Social Security, an increase of more than 23 percent over the past five years. Benefits average a little less than $1,000 a month.

About 8.2 million people receive Supplemental Security Income, a disability program for poor people who don’t have substantial work histories. SSI benefits average a little more than $500 a month.

Coburn said he called for the investigation after he learned that a man he had hired to cut down trees in the yard of his home was also collecting Social Security disability. Coburn said he wanted to learn how widespread cheating was in the system, though the report doesn’t determine whether undeserving people are getting benefits. Instead, the report is limited to whether officials followed proper procedures.

The subcommittee’s staff asked the Social Security Administration to randomly select 100 cases apiece from counties in three states — Virginia, Alabama and Oklahoma. The cases were limited to those in which benefits were awarded.

The investigation was done by both Republican and Democratic staff members. However, subcommittee Chairman Sen. Carl Levin, D-Mich., did not sign off on the final report because he disagreed with some of its recommendations.

The report acknowledged that the findings may not be representative of the entire country. However, it said, “The same types of issues affected decisions across all three counties, suggesting they may be a factor elsewhere in the nation.”

(By STEPHEN OHLEMACHER, AP)

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