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Old 10-07-2013, 12:03 PM  
banyon banyon is offline
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60 minutes: Disability Fraud in the US

For anyone who missed this piece last night on 60 minutes, pretty good overview of the problem that somewhere between 25-40% of disability claims in this country are just straight-up fraud.

Senator Tom Coburn of Oklahoma and his staff should be commended for bringing this important waste of taxpayer funds to our attention.




I have personally seen this in my pratice too, and it usually makes me want to vomit. We will get someone in court who has just gone on a meth lab/burglary spree and the judge will ask them what they will do for employment "I'm getting my disability next month". Way more frequently than it should happen.
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Old 10-07-2013, 12:07 PM   #2
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Yeah I watched. It's sickening.

Seems to me the first step is stopping the government from paying the legal fees of people that fight denial.
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Old 10-07-2013, 12:07 PM   #3
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I'm surprised that the percentage isn't higher than that. A huge majority of people I know that are on disability are shamelessly milking the hell out of it when they could manage work just as well as anyone...
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Old 10-07-2013, 12:14 PM   #4
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Quote:
Originally Posted by jspchief View Post
Yeah I watched. It's sickening.

Seems to me the first step is stopping the government from paying the legal fees of people that fight denial.
Well it certainly looks like that guy from West Virginia and his "man, I'd really like to comment, but i just can't" are on their way to a federal indictment.

The system is set up so that people who have no money or ability to earn money can get their benefits. That's why the lawyers get to take a share, because they don't usually get paid by the hour for this type of work.

The only other system I can think of that would allow impoverished persons to make claims would be to have taxpayer-funded staff attorneys whose job is to represent applicants (kind of like public defenders).

I assume they created the other system as a way to save these staffing expenses, but in doing so, they have created the financial incentive for a proliferation of these type of fraudulent claims.
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Old 10-07-2013, 12:19 PM   #5
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Yep...i would think the number would be higher. I have a few family members (which i don't associate with) who are and have been milking the system for years.

But...i also have a close family member who is a legitimate recipient.

There are those in need, but i have no respect for those jobbing the system.

I didn't watch the video...what is the endgame?
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Old 10-07-2013, 12:19 PM   #6
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A neighbor of mine got busted about 4 years ago for it.
He had a 'back' problem that prevented him from working; was getting a ton of disability $, and short term disability (if I recall).

The insurance company had suspected it and hired a private investigator / or someone from their fraud department and monitored his ass for an entire month; doing chores outside, carrying in groceries etc.

if I recall, he got nailed for it pretty severely. he's since moved out, but it was the talk of the neighborhood for quite a while
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Old 10-07-2013, 12:20 PM   #7
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I wonder if it could be handled on a volunteer basis? Or make the legal fees very small. I think there are probably enough philanthropic lawyers out there willing to donate time to the truly disabled.

The fraud by the people getting undeserved benefits is bad enough. The fact that there's an entire legal industry for helping those people is a criminal lack of proper oversight.
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Old 10-07-2013, 12:37 PM   #8
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I've been on all sides of this [ie, worked for plaintiffs, defendants AND ALJs], and what 60 Minutes is presenting is fairly oversimplified.

Yes, there are friendly judges/ALJs and friendly jurisdictions
Yes, there are whore doctors
Yes, there is an outsized number of subjective complaint cases

But it's still something a bit more than a rubber stamp
Further, it's small potatoes compared to civil cases such as Maritime, Railway, Asbestos, or even Worker's Comp.

There's still defense counsel and ALJs to get past.

A whore doctor is known to be a whore doctor. When an ALJ has his/her years in and has seen 100s of back, fibromyalgia, or carpal tunnel cases, they've seen the same Drs. authoring reports over and over. Defense counsel are entitled to go get their own whore reports as well. They can also engage in private investigation for malingering if they think it's merited.

For every con artist getting over on the system, there's an overly honest/forthright worker with legitimate complaints who the system overlooks or denies callously.

There's a reason for the idiom that the US legal system is the worst, except all others.
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Old 10-07-2013, 12:42 PM   #9
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And the first lawyer arrives...
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Old 10-07-2013, 12:47 PM   #10
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Quote:
Originally Posted by banyon View Post
For anyone who missed this piece last night on 60 minutes, pretty good overview of the problem that somewhere between 25-40% of disability claims in this country are just straight-up fraud.
Fraud implies falsifying an injury/condition to obtain benefits. Pretty much the only fraud mentioned/implied in the piece was the WV version of Better Call Saul.

Disability is an inherently subjective concept. Certain people can function perfectly well with certain conditions (e.g., a fused low back). Others can't. Don't pretend that Dr. Tom Coburn's analysis should control. It's no more authoritative that Dr. Bill Frist saying Terri Schiavo had cognitive brain function. It's just an opinion.

Last edited by Cave Johnson; 10-07-2013 at 01:12 PM..
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Old 10-07-2013, 12:48 PM   #11
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Quote:
Originally Posted by Cave Johnson View Post
Fraud implies falsifying an injury/condition to obtain benefits. Pretty much the only fraud mentioned/implied in the piece was the WV version of Better Call Saul.

Disability is an inherently subjective concept. Certain people can function perfectly well with certain conditions (e.g., a fused low back). Others can't. Don't pretend that Dr. Tom Coburn's analysis should control. It's no more authoritative that Dr. Bill Frist saying Terri Schiavo had cognitive brain function. It's just an opinion.
So do you think there's a significant fraud issue related to SS disabilty?
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Old 10-07-2013, 01:02 PM   #12
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Originally Posted by jspchief View Post
So do you think there's a significant fraud issue related to SS disabilty?
No. Like BL said, whore doctors develop reputations and are largely discounted by judges. It's really a three-fold problem.

1) The SSA uses an outdated database of jobs (the Dictionary of Occupational Titles). It was last updated in the early '90s and needs to be revised to reflect jobs with ever lessening physical demands.

http://en.wikipedia.org/wiki/Diction...ational_Titles

2) There's huge variability in approval rates between offices, leading to disparate outcomes. The same claimant (i.e., same age, work history, and conditions) is far less likely to be approved in Springfield than in St. Louis).

http://www.ssdfacts.com/missouri

3) Disability isn't forever (a fact 60 Minutes glossed over in their hit piece). Most cases are reviewed every 3 years. I think a lot of the "fraud' occurs when claimants get better but aren't kicked off the disability rolls. More resources probably need to be assigned to this review process (more government, yea).

I just gave you about eleventybillion more facts that 60 Minutes did, FTR.
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Old 10-07-2013, 01:06 PM   #13
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So do you think there's a significant fraud issue related to SS disabilty?
The question isn't whether or not fraud exists, so much as it is what you do to combat it.

If you paid attention, there was precious little in terms of prescription in the 60 Minutes piece, more a bunch of generalized 'isn't this scandalous? and how about the way they won't talk to us?'

And fraud isn't black and white, it's more often a continuum.

For instance, I've seen several cases of asbestiosis claims where a guy in his 80s or 90s testifies in deposition that he 'can't get around like he used to.' And that's enough to carry a complaint to $$.

Now the guy isn't necessarily lying, but it's not necessarily proof of a causal relationship between diminished health and asbestos exposure decades ago either. Friendly jurisdictions help, and the appalling story of asbestos industry coverup certainly doesn't.

But it still comes down to 'what legal system would you prescribe to operate better?'
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Old 10-07-2013, 01:09 PM   #14
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Originally Posted by banyon View Post
Well it certainly looks like that guy from West Virginia and his "man, I'd really like to comment, but i just can't" are on their way to a federal indictment.

The system is set up so that people who have no money or ability to earn money can get their benefits. That's why the lawyers get to take a share, because they don't usually get paid by the hour for this type of work.

The only other system I can think of that would allow impoverished persons to make claims would be to have taxpayer-funded staff attorneys whose job is to represent applicants (kind of like public defenders).

I assume they created the other system as a way to save these staffing expenses, but in doing so, they have created the financial incentive for a proliferation of these type of fraudulent claims.
Disability cases are like any other type of contingency work (PI, work comp, med mal, etc.). It's generally a bad idea to take marginal cases where you'll waste your time and litigation costs.

Quote:
Originally Posted by jspchief View Post
I wonder if it could be handled on a volunteer basis? Or make the legal fees very small. I think there are probably enough philanthropic lawyers out there willing to donate time to the truly disabled.

The fraud by the people getting undeserved benefits is bad enough. The fact that there's an entire legal industry for helping those people is a criminal lack of proper oversight.
Legal fees are already capped at a maximum of $6K (in most cases). That's why you see some much advertising..... it's a volume business.
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Old 10-07-2013, 01:14 PM   #15
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Like I already said, I consider the legal industry this has created to be the first target. It's not like Conn (irony) is the only lawyer getting rich off this.

Lawyering people into disability benefits shouldn't be a cash cow.
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