Sunday, May 11, 2014

The $300K/yr Disability Doc Mystery

Social Security Disability uses both part-time and outside physician consultants as examiners for their cases to be rated for both psychiatric and medical conditions. Outside consultants usually do a medical or psychiatric exam for a set fee for each service requested. Each state also, since SSDI is a Federal program administered by states, sets the guidelines for both working arrangements and the in-house fee paid for this work.

In some states, the docs (either licensed medical physicians or licensed psychologists) are part-timers who can work around 25 hours a week. Their fee is either a per-case-rated one or they get paid a flat hourly rate no matter how many cases they rate or don’t rate. It is here that the mystery begins to unfold.

Not that long ago, an investigative reporter for a well-known California newspaper contacted me because he had received my name as a possible source. I had, you see, worked as a medical consultant (in-house and at one time as an outside examiner) for Social Security Disability. His questions were simple, but also quite shocking to me, if I may use the word “shocking.”

The reporter had discovered, by an available database of SSD physician reimbursements, that at least one and most probably more than one physician doing this work had earned $300K a year. Allow me to apprise you as to why this is shocking.

The physician alleges that he/she reviewed and rated 60 cases an hour each day. I do not know the rate of pay they receive in California, a state that is severely pressed for money, but no one could humanly do that many cases in one hour. In all my years of experience, with the most adept medical consultants, I have seen none of them able to do more than 3-4 cases an hour and that’s only on the physical claims. Those for psychiatric/psychological claims are only able to do 2-3 cases per hour because of the complexity of the cases because there are no quick-and-easy measures like blood pressure, sed rates, x-rays, etc. to use as guideposts. Psychiatric cases are dense with material, all written, and all needing careful interpretation.

What rate of pay could California be using and how was that possible, I questioned. He didn’t know but he wanted some idea about what might be happening. The only thing I could conjure up would be if the physician were actually doing what is called “RC” cases.

An RC is where a case has already been rated by one consultant and now needs another set of eyes on ALL the material. It’s supposed to be just like an initial review and not a simple signature in a perfunctory fashion without minutely examining the material. Human nature, it would seem, could push someone to pass cases along and do a bit of robo-signing as they did on all those mortgages that almost brought this country to financial collapse.

Consider another point now. The funds are administered by the state, therefore, if some greedy, lazy person gobbles up a huge portion of the funds, what is left with which to purchase more reviews? Less reviews equals less people having their cases reviewed and who is the loser here? The claimants are the losers because their cases can’t be evaluated if there’s no money to pay someone to do it. How would you view that? I think it’s actionable on some level.

I never heard back from the reporter and I’m wondering how he resolved his dilemma and got responses for his questions. I can only hope he completed the article and some action was taken.