Assessment and Documentation of Youth at Risk of Suicide

EXECUTIVE SUMMARY

The Inspector General began this study after discovering a physician barred from the Medicare program had obtained Social Security disability benefits based upon false medical evidence. The purpose of the study was to determine whether the Social Security Administration's (SSA) administrative structure, and Social Security benefits, were vulnerable to fraud or abuse by physicians with known or suspected problems. (These physicians were those barred from the Medicare program, in default on Health and Human Services loans, or identified by the U. S. Postal Service as

having suspect medical credentials. The study was completed by reviewing all active SSA disability cases from the problem physicians, reviewing employment records of the Social Security Administration and State Disability Determination Service (DDS) offices in the region assigned to this study, and by reviewing DDS records to determine if problem physicians were engaged in providing consultative examinations.

We are pleased that our study surfaced no major problems.

• The Social Security Administration is providing State DDS offices information on debarred physicians, and Disability Determination Service offices are using the listings to screen candidates for consultant services. None of the physicians were employed by the Social Security Administration or by the State DDS offices.
• We did find one physician in loan default and with an indirect role in the Disability Determination Service consultative process. The physician was one of many physicians employed by a clinic providing consultative services.
• The review of disability files on problem physicians did not surface additional fraud.
• We recommend that the State Disability Determination Service offices carefully review medical evidence submitted on behalf of debarred physicians to prevent fraudulent entitlement.