Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) and House Ways and Means Subcommittee on Social Security Chairman Sam Johnson (R-Texas) have called out the discrepancies between Medicare fraud prevention efforts and the lack thereof at the Social Security Administration.
In a statement, Hatch called the current response "woefully insufficient and inadequate." Johnson, meanwhile, pushed legislators to pass his Stop Disability Fraud Act. The bill, proposed this summer, would expand the SSA's fraud investigation units, improve coordination among human services programs, and update medical and vocational guidelines for determining disability.
Despite existing policies and procedures for detecting and preventing fraud, the SSA has a number of vulnerabilities that leave the $200 billion disability benefits program exposed to physician-assisted fraud, according to a recent report from the Government Accountability Office (GAO).
Specifically, the report found that disability and determination services (DDS) staff do not have the resources to adequately detect suspicious claim patterns and are insufficiently trained to spot suspicious medical evidence from physicians.
Additionally, the GAO found staff members reluctant to report potential fraud, since DDS performance measures focus on the speed at which claims are processed. Time spent developing a fraud referral counted against processing times, according to the report.
The GAO recommended SSA "identify ways to remove potential disincentives for detecting and referring potential fraud, enhance its training efforts, evaluate the threat of physician-assisted fraud, and ensure that new and existing fraud efforts are coordinated."
Using Medicare fraud efforts as a model could pay off. As FierceHealthPayer: AntiFraud previously reported, False Claims Act cases reclaimed about $5.7 billion in the 2014 fiscal year.
- see the statement from members of the Senate Finance Committee
- read the summary (.pdf) and full text (.pdf) of the Stop Disability Fraud Act
- read the GAO report (.pdf)