Tag Archives: Social Security fraud

Jessie Holds Court

people, children, technology, friends and friendship concept - hJessie was smaller and younger, but had by far the best ideas, so she was the ringleader.

We lived near a school that sometimes was in session when ours was not.  The school had large-windowed classrooms at its basement level, and if you were a little kid standing outside one of those windows, it was as if you were on a stage, framed in a veritable proscenium arch, optimal for entertaining the captive inhabitants of the classroom therein.

Think of the possibilities.

Once when they were in session, but we were not, Jessie had us dress up “like the girls fromTwo Little Girls Vintage Photograph Little House on the Prairie,” go to the school where we crawled to the window and looked with exaggerated longing into a classroom full of kids about our age.  We were not disruptive.  We were just there … sitting.   Jessie pretended to take notes on a pad of paper.  When the teacher eventually came to shoo us away, Jessie, stuttered out a wistful protest in the most hammed-up, corn-pone delivery imaginable … “we … we … we just want to learn.”

Brought-the-house-down.   Even the teacher.

Ha-ha-ha!  A delightful little childhood story from back in the day when families had five and six and nine kids apiece, and instead of having a helicopter for a mom, our perfectly competent mothers locked us out of the house with the admonishment to “go play.”  You heard the click of the lock, and you went off to … play.  Your mother went into the house to get after her work, and did not feel the least bit of guilt over the transaction.  Those were the days.

I could go on and on with adorable stories of tender childhood adventures and pranks, but as I people, children, misbehavior, friends and friendship concept -think of them … now with the sensibilities of an adult … I realize that a lot of what we did, and thought nothing of at the time, were actually pretty awful things.  No need to plead the 5th given that the Statutes of Limitation run by the time your moms pass on.  But no kidding … we did some pretty awful things.

Here’s one:  the church at the end of our block had a little yard with a swing set, slide and sandbox.  While playing in the sandbox one summer afternoon, Jessie and I discovered a door to the church had been freshly painted bright red.  It was beautiful and fresh and wet … and there we were … with the sand.  Though unimaginable to me now, we threw sand on the door and ran away laughing ourRed Door horrible little heads off.

Ha-ha-ha!  A delightful little childhood story from back in the day. Adorable little rascals, weren’t we?  

Devils more like.

And another:  we found an unlocked window which was a reliable way into the church building and snuck in on Saturdays to play in a classroom set up for Sunday school.  We played with toys and pretended to be teachers writing arithmetic problems and spelling words on the chalkboard.  Nothing profane.  But when we found a utility closet with a sizeable store of Dawn dishwashing detergent, we squirted whole bottles of it in a hallway, ran back and forth to a drinking fountain getting mouthsful of water and spitting them onto the floor creating a dastardly Slip-n-Slide that certainly was an hours-long horror to clean up. 

I knew it was wrong.  But the clean up was the only thing I considered … and then disregarded.  

Were there consequences my ten-year old self wouldn’t have considered?  Did an elderly person happen upon our handiwork and become injured by it?   I don’t know.   Jessie and I went Senior Woman Enjoying Cup Of Tea At Homeblissfully on our way.  Now, too late, I wonder.

In my early adulthood, I had a delightful, elderly neighbor who occasionally invited me in for tea and a chat.  She was mugged on her porch and in the violence was pushed to the ground and broke her pelvis.  It was shocking the degree to which her quality of life abruptly declined.  She was left quite depleted and depressed for the remainder of her days.

The muggers, she said, were “just teenagers.”

She recognized their acts were borne of youthful indiscretion. Indiscretion with a clear and direct potential for the debilitation that occurred though.  Squirting slippery detergent on a floor is not the same as a mugging.  I will restrain myself from obnoxious over-piety to equate them.  But the effect, for all I know, could well have been the same.

Making decisions with inadequate information are unavoidably how all decisions in youth are made.  And they’re often bad decisions.  Many of mine were.

I confess that not only did I make decisions with inadequate information, but I also unconsciously gave too muchTeenage girl depression - lost love - isolated on white backgrou weight to banal personal concerns – my standing among peers, and my fear of crossing Jessie. 

Jessie might have been the ringleader because she had by far the best ideas, but also because she was a bit of a devilish little bully if you didn’t go along with them. 

Disability determinations are often unavoidably made with inadequate information too.  Medical records are necessarily the primary source of information used to determine whether a claimant is disabled.  Medical records almost never directly address how patients function.  And in most cases how a person functions is  the only relevant issue to the question of disability.  

Even diligent scrutiny of every shred of medical evidence can leave a decision maker at an honest wobble as to whether the records prove up a disability or not.  (I attempt to get at this in If it may please the court, I’d like to whisper sweet nothings in your ear.)

The concern is whether decision-makers left in the lurch after all the evidence is considered would slip into using generalized information to make specific decisions in particular cases.

In Scheherazade’s Superpower, I mentioned that a dissenting opinion in a U.S. Court of Appeals case stated that when medical records are unclear, decision-makers are justified to tip the scales in favor of an assumption that a claimant is likely feigning the disability. The case cited a story of fraud.   (Ghanim v. Colvin763 F.3d 1154 (9th Cir. 2014)) 

This is the kind of generalized information I mean.  

It’s jarring to read this advice in case law, but … I rather appreciate the honesty.

EscapingThe stories of fraud, even when true, represent a tiny fraction of the scope of the disability program.  

Nonetheless, the stories are a huge embarrassment to the Administration, to its decision-makers, to private attorneys representing disabled claimants, and to the claimants themselves.  

Everyone is injured by fraud.  Everyone is implicated by fraud.  

Everyone.  Everyone.  Everyone.  Even all the law-abiding everyones. 

With the rise of stories of fraud in the press, and the documented decline in awards of benefits to claimants, one wonders whether these variables are merely correlated, or whether the rise of the stories is a cause of the decline.  The Ghanim case would suggest there is at least some causation. 

One wonders whether, in addition to Social Security’s stringent standard of what must be proven to obtain disability benefits, if claimants’ burden now also includes overcoming the presumption they are frauds at the outset. 

This would make obtaining benefits, even when truly disabled, quite a bit morePocket Watch Swinging On A Chain Black Background difficult.  Especially so if the burden wasn’t stated, but just hypnotically played itself out in the background of decision after decision after decision after decision.

Shhhh ….  When I snap my fingers, you will see fraud everywhere … when I snap my fingers you will see fraud in everyone … shhhh … decide … shhhh … decide … shhhh … decide.

The Social Security Administration is responding to fraud aggressively.  And they should.   They have increased the numbers of fraud units nationwide.  And they have announced it will be responding to fraud … even before it happens … by the use of predictive analytics.  

Predictive analytics allows fraud investigators to predict who might be a “risky person” in an effort to prevent fraud.  Preventing crime before it occurs makes sense.  Right? 

But using predictive analytics to implicate specific persons before commission of  a criminal act … that’s a bit like … like Spielberg’s film, Minority Report where crimes are foreseen by psychic “pre-cogs,” and prosecuted in advance of their occurrence!  

Tom Cruise at the Los Angeles Premiere of 'Valkyrie'. The DireTom Cruise playing the Chief of Pre-Crime bursts into a home, cuffing a suspect saying … “by mandate of D.C. Pre-crime Division, I’m placing you under arrest for the future murder of Sarah Marks, that was to take place today ….” 

It all made a kind of sense until the pre-cogs foresaw Cruise’s character planning a murder of a person he didn’t even know.

Predictive analytics would not be used to prosecute crimes before they’re committed, but would be used, according to Social Security’s Acting Commissioner Carolyn Colvin, to prevent fraudulent applications from being processed.”  

It’s unclear what … “preventing fraudulent applications from being processed” means … but it sounds like it’s … finally an articulation that claimants, or at least some of them, do have the burden to overcome a presumption they are frauds at the outset … before their applications for benefits are even processed, much less adjudicated.  

It’s jarring to hear this from the Commissioner, but … I rather appreciate the honesty.

people, children, television, friends and friendship concept - tWe need … to think this through.  We need to make informed, fully-conscious decisions.

At any rate, Jessie and I were darn lucky there wasn’t a Juvenile Pre-Crime Division back in the day. Although, in our case, we would assuredly have deserved whatever pre-punishment we got.

All people have an interest in disability determinations being made correctly.  The integrity of the program depends on it.

The devils, as always, are in the wayward little rascally details.

Dear Uncle Ervin,

bigstock-Brass-Town-Hall-Sign-On-A-Door-1960540 An article at townhall.com, by Mike “Mish” Shedlock entitled Want to Get on the Disability Gravy Train?  There’s an App For That printed a letter from a reader:

Hi Mish,

I have a niece and nephew in their early thirties.  Both are perfectly healthy.  They have a son bigstock-Happy-Family-24684179with a slight learning disability.  The mom got him on disability and then applied for funds to take care of him and got it.  Her husband, an Afghanistan vet in supply never saw a moment’s action.  He worked at a desk.  When he came home he applied for disability claiming Post Traumatic Stress Syndrome and got on disability.  The wife then applied for money to take care of him.  She got it.  They are also on a long list of other entitlements like welfare.

They bought a new house a little over a year ago and a month ago they both went out and bought two brand new cars!  She actually brags about playing the system.

I have no doubt there are hundreds of thousands or millions doing the same thing.  Needless to say it boils my blood.

Ervin

If I could be so bold, I would like to interject myself into this communication … I would like to say:

Dear Uncle Ervin,  bigstock-Fraud-22749755

Your letter reveals an astonishing array of facts that, if true, indicate you have important personal knowledge of someone committing fraud ongoingly.

While your letter never mentions Social Security disability, but just “disability,” if it is Social Security disability, Social Security’s Office of Inspector General would like to hear from you.   The hyperlink I have provided, takes you to the relevant page on how you can report the alleged, ongoing fraudulent activity.

Social Security’s Office of Inspector General makes reporting such potentially fraudulent actions easy, safe, and secure.   You can reach them online, by telephone, mail, or by fax.   For your convenience I have provided the relevant numbers:

U.S. Mail:  
Social Security Fraud Hotline
PO Box 17785
Baltimore, Maryland  21235

Telephone:
(800) 269-0271 – 10:00 a.m. – 4:00 p.m. Eastern Standard Time
*If you do not reach an attendant, please call (800) 772-1213, which is Social Security’s general number.  Tell the attendant there your information, and it will be relayed to the Office of Inspector General.

Fax:
(410) 597-0118

You may report allegedly fraudulent activities anonymously, however if you choose to remain anonymous, please give very complete information because an investigator would not be able to contact you for further or clearer information should they need it.

Whether you remain anonymous or not, your report and identity will be kept confidential upon your request.

It is understandable that this boils your blood, but it is bigstock-Crime-watch-zone-18522968important that you do more than simply write an email to a columnist at townhall.com.

Social Security disability benefits are extremely important for those who need them.  When these programs are abused it is a very serious matter.

I strongly urge that you do not remain in collusion with your niece and nephew, and that you report their alleged fraud to the proper authorities.

Thank you for being a concerned citizen!

With respect,

DisabilityDunkTank.com

But wait … just one more thing … ….

Uncle Ervin’s letter is pretty breezy on the details.   It refers vaguely to “disability,” but doesn’t mention which disability program – Social Security?  VA?   It references an unnamed state’s programs for supporting caregivers of disabled people.   It mentions new houses and cars, but there’s no mention of how long it took to receive “disability.”   Was it years?   It normally takes years and years and years.

bigstock-Match-Box-with-used-matches-am-21975974The letter is an unpleasant confusion, but does reliably set sparks to the tinderbox.  The letter does serve that purpose well.

Uncle Ervin, I would like you to know that what I learn about my clients while representing them in a disability matter is quite intimate.   I learn some embarrassing facts about my clients.

I’ve had friends ask me to represent them, but  I always refer them to another attorney.   I want my friends and family members to be able to retain their privacy, their dignity.  I want them to be able to present to me their public face and public self revealing to me what they want of their mental and physical failings on their own terms.

This may be what you are seeing in your niece and nephew – what they carefully present to family – especially extended family.   Bragging about “playing the system” might be cover for some humiliating tidbits they do not run out at the family reunion.

When people tell me of folks they “know” are committing fraud, I give the information they need to report the activity.   These are important programs and they do need watchdogging.   Granted.

Mostly, the person backpedals, declining actually to report the matter presumably because they know in their heart of hearts they don’t know what they’re talking about.   Reporting is not mere gossip that makes you feel as if you’re in the know about the complexities of other people’s lives.

Established journalists, columnists, and bloggers receive lots of correspondence from people – naysayers and yaysayers alike.  Printing such correspondence, when it serves merely to shore bigstock-Nerd-Expressing-Doubt-20661956up stereotypic thinking, and ignite anger, but doesn’t offer anything worthwhile … hmmm.

It does fill space.  I will give you that.