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Congressman calls for investigation into doctors roles

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How some doctors earn big money denying disability claims
Michael Schwab, Nashville Tennessean

NASHVILLE, Tenn. – The chairman of a House Ways and Means subcommittee is requesting an investigation into doctors hired to review applications to the federal disability program.

U.S. Rep. John Larson, D-Conn., cited recent reports by the USA TODAY Network in a letter sent Wednesday to the U.S. Government Accountability Office, the federal government’s chief fiscal watchdog agency. 

The network’s reporting “raised concerns about the quality of such reviews and it could result in incorrect eligibility decisions,” a news release accompanying the letter said. 

In Tennessee, an investigation revealed some doctors were racing through applications submitted by people seeking to prove they are too sick or injured to work.

More: Want to know how the federal government grants disability benefits? It’ll cost you.

Tennessean investigation: How some Tennessee doctors earn big money denying disability claims

Paid by the case, doctors were reviewing up to five application files per hour. Experts said such speedy review of applications, which can contain thousands of pages of medical records, isn’t plausible. Lawmakers in Tennessee have already called for an investigation

When the USA TODAY Network requested data from the Social Security Administration to examine the performance of doctors in every state, the agency presented a $2.3 million estimate to provide those public records. 

Larson, who chairs the Social Security subcommittee, is asking the GAO to conduct its own state-by-state examination of doctors’ performances. 

In Tennessee, doctors who review applications are all on contract, paid a flat fee ranging from $30 to $47 per case. Some physicians were billing upwards of $400,000 each year.

Larson is requesting the GAO examine how widespread the practice of paying contract doctors is among states, and report on how much doctors are compensated. He is also asking the GAO to report on what qualifications and performance measures are required of these physicians. Larson has also requested an analysis of the quality of disability decisions. 

The GAO can accept or decline requests from members of Congress. If the office accepts a request, it then assembles a team of experts to conduct an audit. 

The Social Security Administration runs the nation’s disability program, which provides cash payments to Americans who can demonstrate they are too sick or injured to work. The estimated average monthly disability payment is $1,234. The federal government delegates to states the responsibility of reviewing applications to determine who qualifies. 

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States hire doctors to review the application files and make recommendations on an individual’s eligibility for disability. 

Denials can be appealed, but the wait time for a judge can stretch to more than a year

“Accurate and prompt determinations are necessary to allow eligible people to access their benefits and gain relief from economic hardship,” Larson’s letter said. 

In fiscal year 2017, at least 9,570 people died waiting for their disability appeals to be heard. 

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Follow Anita Wadhwani on Twitter: @AnitaWadhwani

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Follow Mike Reicher on Twitter: @mreicher.

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