Expansion of the Cooperative Disability Investigation Units

Members of the National Association of Disability Examiners (NADE) strongly support expansion of the Social Security Administration (SSA) Office of the Inspector General’s (OIG) Cooperative Disability Investigation (CDI) Units.

While the vast majority of claimants for Social Security and/or Supplemental Security Income (SSI) disability benefits are not out to defraud the program, every individual who adjudicates these claims is aware of at least some level of questionable activity on the part of some claimants and/or their representatives.  CDI Units utilize the combined skills and specialized knowledge of OIG special agents, personnel from SSA’s Office of Operations, the state Disability Determination Service (DDS) agencies and state or local law enforcement agencies to:

• Provide the DDS with investigative evidence so it can make timely and accurate disability eligibility determinations
• Seek criminal and/or civil prosecution of applicants and beneficiaries and refer cases for consideration of civil monetary penalties and administrative sanctions as appropriate; and
• Identify, investigate and seek prosecution of doctors, lawyers, interpreters, and other third parties who facilitate disability fraud.

 Currently eighteen CDI Units are operating in seventeen states, with two units in the state of Texas.  Since the inception of the program in federal fiscal year (FY) 1998, CDI units have received more than 9,300 allegations of fraud in the disability programs.  The vast majority of these allegations came directly from DDS adjudicators.  In the first half of FY 2004, the CDI Units saved almost $64 million in the SSA disability programs by identifying fraud and abuse related to initial and continuing disability claims.  In FY 2003, the CDI program saved almost $100 million in the SSA disability programs. Since FY 1998, CDI Unit efforts have resulted in over 5,000 claims being denied or terminated, with projected savings of over $268 million to SSA disability programs and over $146 million to non-SSA programs.  Given the remarkable savings attributed to the CDI Units, NADE urges SSA and the Congress to provide the necessary resources to expand this program to the other thirty-three states as quickly as possible.

CDI investigators are able to gather information in referred cases that is not routinely available to DDS adjudicators during case adjudication. In many of the referred cases, particularly those involving mental impairments, extreme functional limitations are alleged‑‑such as the inability to cook, shop, drive, do chores, or even bathe and dress.  In the course of adjudication, the DDS adjudicator would normally only receive information supplied by the Activities of Daily Living questionnaire (a self completed or interested third party completed report of function), the treating source(s) (often times non-existent), and/or a consultative examination.  The evidence obtained by the DDS presents a picture of very extreme limitations and/or significant inconsistencies in the information provided.  By referring a case to the CDI unit, the DDS adjudicator is able to obtain crucial information to assist in making the correct decision on the case.  The CDI Unit can do surveillance and observe the claimant’s activities at his/her residence or when he/she goes out.  Investigators can conduct unannounced interviews of the claimant and neighbors or other third parties. During formal investigations, obvious inconsistencies are often found between what a claimant alleges and what he/she is actually observed doing. Or formal investigations can confirm the limitations alleged by the claimant.   In either event, information obtained via the formal investigations can be crucial to arriving at the correct decision to allow or deny Social Security or SSI disability benefits to the claimant.

Because CDI investigators are often able to obtain information from employers, neighbors, motor vehicle records and other sources which the DDS adjudicator cannot, CDI Units are extremely helpful in investigations of unreported or under reported work activity.  As an example:  A claimant reported no work and no earnings.  However, during the course of adjudication, it appeared that the claimant was working as a taxi cab driver. The case was referred for formal investigation and this work activity was observed by the CDI investigator.  It was subsequently determined that the claimant had been working as a taxi cab driver for many years. He had never reported either the job or the earnings and the earnings did not show up on any of the SSA records.  Had this work not been discovered, the claimant would have erroneously been allowed disability benefits.

CDI investigators are also useful in adjudicating difficult Continuing Disability Review (CDR) claims in which irresolvable inconsistencies exist in the file.  One such case involved a beneficiary who claimed to be wheel-chair confined.  Although there was no documented medical reason to cause the individual to be wheel-chair confined, there was nothing in the file to contradict the claimant’s allegations. The case was referred to the CDI unit for formal investigation.  Surveillance by the CDI Unit, which included a videotape of the individual walking without difficulty, allowed the DDS to cease disability benefits for this particular individual.

The national news media have, in recent years, widely reported on the delays that occur in the processing of disability claims.  Although not as widely reported, the news media have also reported on many cases of fraud and abuse in the disability program.  Such reports offer further anecdotal support for the expansion of the CDI units.

The Social Security and Supplemental Security Income (SSI) disability programs provide an essential safety net for disabled adults and children.  Individuals applying for Social Security or SSI disability benefits are among the most vulnerable of this country’s population.  In addition to the devastating financial and psychological effects of a sudden or chronic illness or injury, many applicants are poorly educated, do not speak English or have poor life coping skills.  These individuals are often victims, themselves, of unscrupulous interpreters, third parties or others who are out to defraud the program.  CDI units are cost effective and provide a visible and effective front‑line defense against fraud, waste and abuse in the SSA and SSI disability programs; they also provide valuable protection to the Social Security Trust Fund, to the American taxpayer and to the victims of those who are attempting to defraud the program.

Approved by the NADE Board, July 1, 2004