While the benefits of Social Security Disability Insurance (SSDI) may be modest, they are essential and relied on by individuals with disabilities. This is why it’s important that the Social Security Administration (SSA) prevents its funds from falling into the wrong hands.
Keeping in mind the widespread fraud in Social Security Disability cases, the SSA has implemented new measures to prevent fraudulent claims. These measures include but are not limited to, the use of technology to a great extent and the creation of a fraud prevention unit.
This article sheds light on recent developments adopted to prevent fraud in SSDI claims.
Fraud Payments in SSA
According to the SSA, about 1% of all disability payments are fraudulent. This data serves as a harsh reminder of the widespread nature of fraudulent activity in Social Security disability claims. It is important for those in charge of maintaining the system’s integrity and anybody thinking about claiming disability benefits to take note of this.
Fraud Prevention at the Start of the Application Process
In order to prevent fraud from occurring, it’s necessary to look for it before it happens. The SSA has adopted the following measures to prevent fraud from happening at the start of the application process.
Use of Predictive Data Analytic Systems
A number of private disability insurance businesses use predictive data analysis tools, which can recognize warning indications or patterns, screen applications for risk factors in real-time, and detect fraudulent activity before it takes place. In order to enhance its fraud detection skills, the SSA is presently conducting tests with several predictive analytics solutions.
Raising Fees for eCBSV
As part of the Economic Growth, Regulatory Relief, and Consumer Protection Act of 2018, Congress mandated that the SSA set up a database for financial organizations that can check an applicant’s Social Security numbers for a fee. This is called the Electronic Consent Based Verification Service or eCBSV.
The method gives authorized users an instant “yes/no” response after determining whether an applicant’s name, social security number, and date of birth are in line with the SSA records. In addition to this, it will also inform them if the information that they have provided is identical to that of a deceased person.
Fraud Prevention Units
Fraud prevention units (FPUs) are comprised of teams that are frequently used to detect fraud. Disability inspectors who work in Fraud Prevention Units review and find suspicious disability claims flagged by data analytics. When required, they also assist the Office of Inspector General with fraud investigations.
The SSA has already started using these teams for SSDI fraud prevention. In 2014, the Social Security Administration launched the first three FPUs in the cities of New York, Kansas City, and San Francisco.
Data Matching
The Social Security Administration stores most of its claims in scanned paperwork, which cannot be searched. With a thorough data profiling system, the Social Security Administration keeps tabs on and compares data on doctors, claimants’ advocates, and agency workers.
This helps the SSA identify cases where certain attorneys or claimant advocates have higher allowance rates, where many claims are filed by the same doctor claiming the same medical condition, or where the amounts claimed are identical.
Additionally, in an effort to curb fraud via the portal, the SSA is working to improve online authentication.
Updating Medical and Occupational Guidelines
Despite medical and technological advancements, medical and occupational guidelines have remained unchanged for decades. More effective treatments for certain diseases have made patients’ quality of life much better, and many jobs that don’t require a lot of hard work are now easier for disabled people to do.
The SSA is reviewing potential changes that would allow it to more accurately incorporate applicants’ ages, levels of education, and employment histories into the overall eligibility assessment.
Using Social Media
During assessments, social media may be used to confirm the claims made by applicants. The Office of the Inspector General (OIG) has discovered evidence of SSDI recipients participating in extremely strenuous physical activity.
The Social Security Administration is employing surveillance measures that allow it to keep tabs on applicants by tracking their social media activity and finding out whether they are actually disabled.
How to Prevent Fraud During Appeals Process and After Approval
This section talks about the different fraud prevention measures that SSA employs after the benefits have been approved.
Identifying Appeal Judge
The Office of the Inspector General (OIG) has found that judges accept between 8.6 and 99.37 percent of cases, implying that the acceptance rate varies significantly. Judges who approve a higher number of cases have been marked as “outlier judges.” By improving its data analytics system, the SSA will be able to identify the factors that lead to this approval rate and implement changes accordingly.
For example, it was claimed that a judge in Huntington, West Virginia, conspired with an attorney to grant benefits to individuals who otherwise would not have qualified.
Clearing Disability Review Backlog
The Social Security Administration checks claimants’ eligibility for payments on a regular basis. There was a decrease in financing for continuing disability reviews from 2002 to 2008, and no specific funding was supplied from 2004 to 2008, despite studies showing significant returns, resulting in $9 in savings for Social Security programs for every $1 spent.
As expected, a reduction in Clearance Disability Review and a substantial backlog (1.3 million medical continued disability reviews (CDR) were overdue in 2013) resulted from reduced financing. The medical CDR backlog is estimated at $11.8 billion, and the SSA is trying to fix this problem.
Rules for Terminating Benefits
Current policy requires that before stopping a claimant’s benefits, the SSA must find a medical improvement in the claimant’s disability. Deciding when to stop benefits can be challenging in cases where the initial decision made on the disability of the claimant was not adequately documented or was not fully supported by the evidence that was on file. A better training program for staff might help solve this problem.
Conclusion
It is important for the SSA to ensure SSDI fraud prevention in order to uphold the rights of disabled people. The recent initiatives taken by the Social Security Administration are decisive steps towards preventing fraud in SSDI claims.
