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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, 01:41 PM   #31
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Originally Posted by Cave Johnson View Post
Also, this is a pretty good example of fraud and abuse.
Why would that be?

Many ALJs, particularly those newer to the process, devote their time to conferences and mediations that foster voluntary settlement between the parties, most often in the smaller and more cut and dried cases.

Why should an ALJ with a heavy caseload of clear-cut cases take many of them to hearing, when the parties can be encouraged to voluntarily settle amongst themselves?
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Old 10-07-2013, 01:43 PM   #32
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Originally Posted by Baby Lee View Post
Why would that be?

Many ALJs, particularly those newer to the process, devote their time to conferences and mediations that foster voluntary settlement between the parties, most often in the smaller and more cut and dried cases.

Why should an ALJ with a heavy caseload of clear-cut cases take many of them to hearing, when the parties can be encouraged to voluntarily settle amongst themselves?
Dude, I think you're conflating WC ALJs with SSD ALJs. There's no such thing as a conference or mediation in SSA-land (or defendants, for that matter).

Last edited by Cave Johnson; 10-07-2013 at 01:55 PM..
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Old 10-07-2013, 01:45 PM   #33
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Here's a slightly more nuanced series from NPR, if anyone's interested.

http://apps.npr.org/unfit-for-work/
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Old 10-07-2013, 01:47 PM   #34
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Oh, possibly.

You rigorous standards for culpability would serve the legal system well!!
Right, because I'm supposed to pretend all lawyers would have no reason to support the system in its current form. Totally free of bias I'm sure.
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Old 10-07-2013, 02:46 PM   #35
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Quote:
Originally Posted by Baby Lee View Post
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.

Appreciate your perspective on this BL. I guess when you say it's "small potatotes" compared to the others you list, those others are payments from private entities and not taxpayers, correct?

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Originally Posted by Baby Lee
There's still defense counsel and ALJs to get past.
I've only done a couple of SSA disability hearings in my career, but I don't remember there being any advocate on the other side. Am I wrong about that? Would that help?
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Old 10-07-2013, 02:49 PM   #36
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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.
They interviewed numberous people associated with the disability claims system, including former attorneys at Binder and Binder who claimed that the abuse was widespread.

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Originally Posted by Cave Johnson
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.
I think Coburn's report was supposed to come out today, but I was under the impression from the 60 minutes piece that it wasn't like Frist watching someone on TV and then shooting a medical opinion on the fly from 2 minutes observation. 60 Minutes claimed that Coburn had two staffers working full time on this report for the better part of two years. I assume the level of detail and sourcing will be quite different in scale and kind.
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Old 10-07-2013, 02:50 PM   #37
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Quote:
Originally Posted by banyon View Post
Appreciate your perspective on this BL. I guess when you say it's "small potatotes" compared to the others you list, those others are payments from private entities and not taxpayers, correct?

I've only done a couple of SSA disability hearings in my career, but I don't remember there being any advocate on the other side. Am I wrong about that? Would that help?
See post 32.
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Old 10-07-2013, 02:52 PM   #38
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Originally Posted by Cave Johnson View Post
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.
Unless the threshold for successful claims is set too low, then you should take on as many as possible.
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Old 10-07-2013, 02:56 PM   #39
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See post 32.
Yeah you beat me to it.
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Old 10-07-2013, 02:57 PM   #40
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They interviewed numberous people associated with the disability claims system, including former attorneys at Binder and Binder who claimed that the abuse was widespread.
I doubt any former attorneys have anything nice to say about their time at Binder and Binder. It's a legal factory. As for the field office workers, they're in economically depressed WV, where the incentives for filing for disability outweigh the limited job opportunities. Their experience is hardly reflective of the nationwide picture.

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Originally Posted by banyon View Post
I think Coburn's report was supposed to come out today, but I was under the impression from the 60 minutes piece that it wasn't like Frist watching someone on TV and then shooting a medical opinion on the fly from 2 minutes observation. 60 Minutes claimed that Coburn had two staffers working full time on this report for the better part of two years. I assume the level of detail and sourcing will be quite different in scale and kind.
I tend to doubt they conducted anything more than a file review. As an attorney, you should know that conducting an interview or hearing allows the kind of subjective credibility determination that a paper file review can't possibly offer.
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Old 10-07-2013, 02:57 PM   #41
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Originally Posted by banyon View Post
Appreciate your perspective on this BL. I guess when you say it's "small potatotes" compared to the others you list, those others are payments from private entities and not taxpayers, correct?



I've only done a couple of SSA disability hearings in my career, but I don't remember there being any advocate on the other side. Am I wrong about that? Would that help?
Re: small potatoes; WC, Fela, Jones Act and Occupational Exposure are often private industry, but are not limited to private industry. Government workers are paid by the relevant employer insurance fund [ie, naval vessels have a large number of asbestos claims, government data entry causes carpal tunnel the same as private, etc.]. Further SSDI is insurance, not taxpayer funds. It does come from a payroll tax, but is enacted as government run insurance.

Re: SSDI defense. True at the primary level, ALJs are charged to represent the government's interests under the purpose of the legislation, as opposed to WC or unemployment where the ALJ is charged with neutrality and each party secures counsel [though many states charge the system with liberality towards claims, at least prior to hearing, and ALJs are authorized to advise unrepresented injured workers generally of their rights in preliminary meetings]. But government counsel handles SSDI appeals.
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Old 10-07-2013, 03:00 PM   #42
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Originally Posted by Cave Johnson View Post
I doubt any former attorneys have anything nice to say about their time at Binder and Binder. It's a legal factory. As for the field office workers, they're in economically depressed WV, where the incentives for filing for disability outweigh the limited job opportunities. Their experience is hardly reflective of the nationwide picture.
That was kind of one of the points of the piece though, that SSA Disability is being utilized as a de facto long term unemployment plan, but with no legal authority to do so.

The attorneys from Binder and Binder didn't seem especially embittered to me, though they did refer to it as a "legal factory" as you did. I think you ought to watch the piece to give it a fair shake.



Quote:
Originally Posted by Cave Johnson
I tend to doubt they conducted anything more than a file review. As an attorney, you should know that conducting an interview or hearing allows the kind of subjective credibility determination that a paper file review doesn't.
Depends. Sometimes fraud is so blatant that it can jump off the paper at you too. If you are dealing on this massive of a scale, I don't know what other type of review would be feasible.
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Old 10-07-2013, 03:02 PM   #43
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They are conducting hearings on CSPAN3 right now on this with Coburn.
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Old 10-07-2013, 03:03 PM   #44
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http://www.coburn.senate.gov/public/...4-86e7890232f1


Key findings of the report include:

• Daugherty Awarded More Than $2.5 Billion in Benefits in the Last Years of His Career. Judge Daugherty moved an unusually large number of disability cases through the agency and awarded an unusually high percentage of disability benefits. Over a nearly seven year period, from 2005 to his retirement in mid-2011, Judge Daugherty awarded disability benefits to 8,413 individuals, which translates into about 1,200 cases per year and an estimated total award of federal lifetime benefits exceeding $2.5 billion.

• Judge Provided “DB Lists” to Conn Law Firm. From at least June 2006 to July 2010, 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. Over the four year period reviewed, from 2006 to 2010, the monthly list identified between 14 and 52 disability claimants each time for at least 1,823 claimants. Conn Law Firm personnel referred to the monthly list as the “DB List” for David B. Daugherty.

• Daugherty Relied on Conn’s Doctors to Generate Medical Evidence. After receiving the DB List, Mr. Conn’s office scheduled appointments for the identified claimants with certain doctors favored by the law firm. The Conn law firm provided several of those doctors with physical or mental residual functional capacity (“RFC”) forms in which the medical information was already filled out, and the doctors signed the forms without making any changes. Frequently, these pre-filled forms contained information that conflicted with other information in the claimant’s case file.

• Identical Medical Evidence Used for Multiple Claimants. A review of the RFC forms found that the Conn law firm supplied certain doctors with 15 pre-filled versions of the physical RFC form and five pre-filled versions of the mental RFC form for hundreds of claimants. In almost all cases, only the names and Social Security numbers on the forms differed. Of the forms reviewed, 97 described the claimants as having the exact same limitations and contained no unique medical or employment information specific to the claimant. Because each individual has different abilities and ailments, and the forms require a complex set of data, finding two RFCs exactly alike should have statistically been an extremely rare occurrence.

• Key Doctors Had Suspect Credentials. Of the doctors used by the Conn law firm to produce medical opinions for disability claimants, two had their medical license suspended or revoked in another state. Under SSA rules, a doctor with a suspended or revoked license could not be used by the Social Security Administration to review a disability case, but could still examine claimants at the request of a claimant or outside attorney.

• Judge Daugherty Wrote Questionable Decisions Relying on Mr. Conn’s Doctors. A review of 110 case files for disability claimants listed on the DB Lists found the vast majority to contain highly questionable decisions. In all 110 cases, Judge Daugherty’s decisions justified reversing the agency’s prior denial of disability benefits by relying solely on the medical forms provided by the doctors procured by the Conn law firm. All but two of the 110 cases used the agency’s Medical-Vocational grid guidelines to award benefits.

• Mr. Conn Obtained Millions in Attorney Fees Paid by SSA. From cases on the DB Lists alone, over the four year period from 2006 to 2010, the Social Security Administration paid Mr. Conn over $4.5 million in attorney fees.10 Social Security records show that, altogether in 2010, 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. In 2009, Mr. Conn received a total of $3.5 million in attorney fees from the agency.

• Mr. Conn Paid Doctors Substantial Fees for Evaluations. The doctors used by Mr. Conn to evaluate his claimants were also paid substantial fees. A review of records found that, over the past six years, Mr. Conn paid five doctors almost $2 million to provide disability opinions for his claimants. Mr. Conn contracted with his claimants to repay the fees given to the doctors to perform their medical evaluations.

• Daugherty Bank Records Show $96,000 in Unexplained Cash Deposits. From 2003 to 2011, Judge Daugherty’s bank records contain regularly occurring cash deposits totaling $69,800, the source of which is unexplained in the judge’s financial disclosure forms. From 2007 to 2011, his daughter’s bank records list similar cash deposits totaling another $26,200. When asked about the $96,000 in cash deposits, Judge Daugherty refused to explain their origin or the source of the funds.

• SSA Whistleblower Targeted by Huntington Chief Judge Andrus and Eric Conn. Following the public disclosure of Mr. Conn’s relationship with Judge Daugherty, Huntington Chief ALJ Andrus worked with Mr. Conn to discredit and retaliate against an SSA employee suspected of leaking the information.

• Mr. Conn Destroyed Documents during an Investigation. After talking with SSA OIG investigators, Mr. Conn contracted with a local shredding company to destroy over 26,000 pounds of documents, the equivalent of 2.6 million sheets of paper. Former Conn law firm personnel asserted that he destroyed all hard copies of the DB Lists as well as computer hard drives in his office.
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Old 10-07-2013, 03:06 PM   #45
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