Disability fraud is common, and it is known to be common. Setting up processes with preventative internal controls is always more expensive than relying on detective controls. We have a disability program that is so far in the red that jobs are being cut on the enforcement/investigation side, d the detective controls, which were never very effective to begin with, are not being performed. As an example I would point to the expenditures made by the Louisiana 2nd injury board. They have met their statutory cap each of the last three years, after having never come close to it in the history of the program. I'm sure by starting with te analystics a good fraud examiner could uncover massive fraud and waste, but when I bill myself on fraud engagements it is $275 an hour, and $350 if you want to testify. On days I testify there is a 10 hour guarantee. I've been engaged by a number of insurance companies, but never by a government.
I never said the system was "foolproof", you made that up. What I questioned was the assertion that that fraudulent Boomer disability claims made up the bulk of those on "assistance". I still question that. Now you are stating the obvious. Everybody agrees with that. What I questioned was the statement that judges did not challenge doctors and that doctors routinely lied under oath to get disability benefits for people. The doctors really have no incentive to do this. Most applicants for disability are turned down. And what I said was that people who have paid into the system have a right to make a claim, not that they have a right to be awarded. What I was getting at was the fact that there are people who have never paid into social security that make SS disability claims. I do not pay into Social Security and am not eligible to receive it or SS disability. I pay for private disability insurance. Is there fraud? Sure. But the suggestion that the entire system is corrupt and people can just get disability for the asking is untrue. Are more people receiving disability? Sure. But there are huge numbers of aging Boomers, the numbers are bound to go up. Do the requirements for disability need to be tightened? Perhaps. But we must consider that if these people can no longer work they will end up on Medicaid, food stamps and public housing costing us far more than $1100/month in disability benefits. Agreed. But don't turn into Gyver and condemn the entire system because of some abuse. There are people who are legitimately disabled, who have paid into the system, and are deserving of a few years of help before they qualify for SS and Medicare.
There are doctors who routinely lie under oath. I have seen it firsthand moe than once. One of the analytics I run for insurance companies is to look for doctors who testify in multiple cases monthly. Usually this occurs because the doctor is an expert, but sometimes it is because the doctor has a file full of x-rays and templated reports. I kid you not, I investigated one claim back when I lived in Georgia, and when I was reviewing the physician's report and orders I recognized the doc's name frm another investigation. I cross referenced it with another file I had reviewed that was from a different district, and the reports were identicle. All the doctor did was change the patient's name. Same spelling errors and everything. That one got turned over to GBI, but they never did anything it it. Not sexy enough.
What incentive do doctors have to lie under oath? The potential penalties are serious. And I can't imagine that people applying for an $1100 disability check have the means to bribe well-paid doctors with anything that would impress them. I understand that lawyers are hired guns which likely explains why fewer denials are made by the review judges than the Social Security officials. But doctors? What's in it for them to lie about a phony disability, especially under oath? Got to be a reason.
That is not an explanation. What's in it for them to lie under oath so that a stranger receives disability?
I'm sure some docs make a living that way. I assure you doctors are not going to court to testify for a patient for free. They're getting something out of it. Not a ton, but something. Due to the fact that it is an opinion, it is virtuatlly impossible to prove perjury in a situation like that. Plus, you help a few people out and then you get a few more to come your way. I'm not suggesting that doctors are recruiting people for a scheme, but I'm sure they're not investigating thoroughly when someone complains of pain in the interest of making a buck.
Generally speaking, there is an associated fee schedule and the doctor gets a percentage of the disability claim. You get enough patients on disability roles you get some nice annuity income. This is more of a problem with private insurance, but in districts with weaker judges this occurs in disability courts as well. Many judges do not have the sufficient medical knowledge to challenge a doctor's report. some ask tough questions, but a slick sounding answer will usually suffice.
So what are the checks and balances? If higher reviews and review courts are upholding judges decision by 97% to 99%, then there isn't much room to suggest judicial corruption. Do judges not take perjury seriously as they should? Is the medical community invested at all in seeing to it that its doctors are accountable giving expert witness testimony? Most medical decisions are not opinions and even in those that are, there are established best practices as guideline for doctors to follow. Credibility is everything when considering an expert witness. A good expert witness in any field makes sure that he is speaking in terms a judge or jury will understand. A slick-sounding answer and he will be taken for a Slickster. There are jargonmasters in all disciplines, but it rarely fools the astute. It's the lawyers that are fucking everybody, isn't it?
I'm not sure what the checks and balances are with respect to oversight of stuff like that but I can tell you that in my observations of the AMA, they're as interested in maintaining maximum earning potential as they are with anything else.
