Filed Under:Health Insurance, Individual Health

Social Security Sends Out the Detectives

(AP Photo/Jacquelyn Martin)
(AP Photo/Jacquelyn Martin)

Witnesses at the latest House hearing on the problems at the Social Security Disability Insurance program swapped tales of outrageous cases of false claims.

The Social Security subcommittee at the House Ways and Means Committee organized the hearing to continue with its ongoing efforts to improve SSDI operations.

Private disability insurers care deeply about the health of the SSDI program because many coordinate their benefits with SSDI benefits.

Patrick O'Carroll Jr., the inspector general for the Social Security Administration (SSA), shared a story about a Washington state couple that bilked SSDI and other SSA and state programs out of about $300,000.

The husband obtained a second Social Security number using a fictitious name in 1982, then, in 1993, used the fake number to apply for SSDI. He claimed he was profoundly disabled. His wife went to an SSDI interview with him, pretended to be his neighbor, and assured the interviewer that the man could not work.

An investgation revealed that the man bought and sold used cars, lived in a $430,000 house and had more than $10,000 in his bank account, O'Carroll said in a written version of his testimony posted on the Ways and Means website.

The man and his husband pleaded guilty to Social Security in September 2011. He was sentenced to 27 months in prison, and he and his wife were ordered to pay about $300,000 in restitution, O'Carroll said.

Thomas Brady, a Kansas City, Mo-based special agent in the Office of the Inspector General for the SSA, and Paul Neske, a detective with the St. Louis County Police Department,

Brady talked about staking out a woman who claimed she needed SSDI because she had terrible back pain and needed a cane to walk. Brady and Neske watched her and found that the woman had intermitten difficulties with walking that appeared only when she was visiting the offices of doctors and others in charge of determining whether she was eligible for SSDI.

SSA officials have emphasized that SSDI overpayments are rare.

Rep. Sam Johnson, R-Texas, chairman of the Ways and Means health subcommittee, acknowledged that the SSDI program has an overpayment rate of just 1.5%.

But annual SSDI program costs are $124 billion, Johnson said.

"In fiscal year 2010, each tenth of a percentage point in payment accuracy represents about $706 million in retirement and disability program outlays" Johnson said. 

Steve Clifton, president of the National Council of Social Security Management Associations, said SSA offices are desperate for more funding that they can use to expand the operations responsible for adjudicating claims and verifying program integrity.

He shared results from a council survey of SSA managers.

"We are down to 24 (from 30) employees, and one of our [employees] just suffered a major heart attack," one manager wrote.

Another wrote about running an office was at a historically low staffing point. "Yet we are providing assistance to another office that is down from 21 to 12 employees in the span of about a year," the manager wrote.

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