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Social Security-Soft On Disability Fraud Frontline Staff Questions Agency's Commitment To Fighting Fraud Supplemental Security Income (SSI) and other benefit programs such as Medicaid may be losing millions of dollars each year due to fraud. Individuals who fake disabilities in order to claim benefits continue to get the help of unscrupulous medical providers and middlemen. Although the actual number of people who fake injuries and illness is unknown, the U.S. General Accounting Office (GAO) says the program remains vulnerable to this type of fraud and abuse despite anti-fraud initiatives. It is estimated just one individual who obtains benefits illegally will cost the government $122,000 in SSI and Medicaid benefits over the next 10 years. For a fee, middlemen help ineligible non-English speaking applicants obtain SSI benefits illegally, coaching applicants on how to appear disabled. Also, unscrupulous health care providers submit misleading diagnoses in order for SSI applicants to collect benefits; in most states medical providers can bill Medicaid for treating SSI recipients. A recent study conducted by the GAO showed 60% of SSI beneficiaries had impairments including psychoses, schizophrenia, and other mental and physical disorders that were difficult to objectively verify. Providers who have been investigated for defrauding Medicaid, Medicare, or private insurance companies furnished at least some portion of the supporting medical evidence for more than 6% of the disabled recipients in the states reviewed. Over 96% of the 158 officials and staff interviewed said they believed the practice of middlemen helping people improperly qualify for SSI benefits continues. As of March 1999, pilot anti-fraud teams in just five locations provided information that led to stopping SSI benefits worth about $11 million. Yet the GAO calls the Social Security Administration's (SSA) effectiveness "limited." The GAO says front-line staff lack "valuable information, such as the names of middlemen and medical providers suspected of fraudulent or abusive practices." In addition, the GAO said SSA staff "do not always follow the new procedures because they believe the procedures conflict with agency work incentives that stress speed in processing claims..." The GAO further states that staff "also question the agency's commitment to fighting fraud, since they repeatedly see the same suspicious middlemen and medical providers involved in SSI cases, despite previous referrals for investigation." The GAO report cited the need for developing a comprehensive database on suspicious middlemen as well as another of medical providers suspected or convicted of Medicaid fraud that could be shared agency-wide. The information could alert staff to suspicious cases. The GAO further suggested the SSA provide incentives to employees to tracking suspicious cases. Source: "Supplemental Security Income: Additional Actions Needed To Reduce Program Vulnerability To Fraud And Abuse," GAO/HEHS-99-151, September 1999. This article first appeared in Volume 5, Issue 4 of "The Social Security and Medicare Advisor" newsletter (March/2000). To receive future editions of "The Advisor" in its special, free e-mail version, please click here. | ||||||||
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