According to the Wall Street Journal, Federal investigators recently searched six facilities in Puerto Rico as part of a broadening probe into potential widespread disability fraud. Investigators from the Federal Bureau of Investigation and the Social Security Inspector General’s Office, among others, searched five doctors’ offices and one other location as part of their sweep, a spokeswoman for the U.S. attorney in Puerto Rico said. The spokeswoman wouldn’t comment further, saying it was part of a continuing investigation and that the six search warrants were sealed.
In 2006, 36% of initial applicants in Puerto Rico were awarded benefits. In December 2010, the award rate had jumped to 69%. By 2010, nine of the top 10 U.S. Zip codes for workers receiving disability benefits were living in Puerto Rico. At the time, SSA officials said the high number of recipients and the high award rate was due to the island’s weak economy and a lack of adequate health care for workers. The characteristics of Puerto Rico’s beneficiaries differed from other areas. In addition to the large clusters in certain zip codes, federal data showed that 33.3% of Puerto Rican beneficiaries qualified because of “mood disorders,” a rate that is at least 10 percentage points higher than any U.S. state.
Doctors play a big role in determining whether people qualify for federal disability benefits because their recommendations often sway state and federal examiners. Criminal investigators have been looking into whether doctors were paid to improperly create documents detailing applicants’ inability to work, people familiar with the probe said.
The federal investigation into disability fraud was launched in 2011 an article in The Wall Street Journal revealed widespread disparity in how some states and U.S. territories implement the Social Security Disability Insurance program. The chances of winning benefits could vary widely based on where someone applied for benefits, even though standards are supposed to be uniform. Disability examiners and federal judges say mental disorders are harder to measure and often rely on medical opinions issued by doctors to make a determination.
SSDI was designed as a way to provide benefits for people who cannot work because of mental or physical health problems, and Americans can qualify for benefits because of ailments ranging from severe back pain to terminal cancer. A lifetime of benefits, including access to Medicare, can cost the government about $300,000 a person. The program became a safety-net-of-last-resort for millions of Americans during the recent economic downturn, including many who had collected unemployment benefits and had hoped to return to the workforce. SSDI had 7.6 million beneficiaries in 2003, and that number swelled to 10.9 million by the end of 2012. More than 200,000 of the beneficiaries are in Puerto Rico, according to federal data. SSDI paid out $136.7 billion in disability benefits last year, almost twice as much as the government spent on food stamps. The vast majority of people who receive disability benefits never leave the program to return to the workforce.
