Lawsuits Allege Fraud in Social Security Disability Decision-Making Process

 Posted on November 23, 2022 in Social Security Disability

It is not uncommon for a person who files a claim for benefits under the Social Security Disability Insurance (SSDI) program to be told that additional medical evidence is required. In many situations, applicants are required to undergo a consultative exam with a medical professional who is approved by the Social Security Administration (SSA).

Generally, there are at least a few approved contractors in a given geographic area who can provide such exams, but according to several lawsuits that were filed recently, some of them may not be providing the level of honest care that applicants should expect. Such was the case, allegedly, for a woman in Kansas City who sought a consultative exam as part of her 2018 SSDI application process.

Questions About the Consultative Exam

According to local news reports and court documents, a Kansas City woman applied for disability benefits in 2018, stating she could not work due to a number of health issues, including neck and back pain, carpal tunnel syndrome, hip surgery, arthritis, and constant migraines. As part of the application process, she visited a particular SSA-contracted medical provider in Kansas City.

The woman said that the doctor spent under 10 minutes with her without asking her any questions whatsoever. She also said that the report filed by the doctor indicated her ability to “use her fingers and hands to button and unbutton a shirt,” despite the fact that she was not wearing a button-down shirt, nor was she asked to button or unbutton anything during the exam.

The woman’s SSDI application was subsequently denied.

Accusations of Fraud

An attorney from a local law firm told a local news outlet that he was able to find nearly 250 other individuals with stories similar to that of the woman. They all visited the same contracted medical provider for consultative exams, and their reports all included similar indications regarding buttoning a shirt or turning a doorknob. The provider’s exam rooms do not have doorknobs.

The attorney is part of a team that has subsequently filed a series of lawsuits in civil court, naming the medical provider, the individual doctors in question, and the Social Security Administration as defendants. The suits allege fraud and that the doctors were simply trying to get through as many patient exams as possible. Part of the evidence, the suits claim, is the “canned findings” such as the buttoning of clothing.

Records show that the SSA pays this particular provider about $185 per consultative exam and that the provider has been paid more than $7 million since 2012 by the SSA alone.

Officials from the provider group defended the company’s actions, saying that they follow the SSA’s standards. A statement from the company’s president said that the company has no reason “to provide anything other than honest and fair examination,” because the company gets paid the same regardless of whether the applicant receives SSDI benefits.

The SSA would not comment on pending legal matters.

Work With a Texas SSDI Attorney

If you have applied for Social Security disability benefits and you are concerned that your consultative exam was not handled properly, contact a Dallas disability lawyer. Call 972-671-9922 for a free case evaluation with The Law Offices of Coats & Todd today. We will work hard to ensure that your rights, best interests, and eligibility for benefits are fully protected.

Source:

https://www.kshb.com/news/local-news/lawsuits-lay-out-accusations-of-fraud-within-social-security-disability-program