September 26, 2022

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Social Security Administration: Actions Needed by SSA to Ensure Disability Medical Consultants Are Properly Screened and Trained

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<div>Why This Matters Social Security disability benefits are generally intended to help people who cannot work due to a disability. All of the state agencies that review disability claims consult with physicians to evaluate claimants' medical eligibility. Concerns have been raised about: SSA's oversight of states' consultants, and Whether paying contract consultants per claim affects the quality of their work. Key Takeaways SSA cannot be sure that the state agencies' consultants are qualified and trained to appropriately inform decisions on disability claims. SSA policy requires state agencies to screen their consultants by checking them against a database of individuals barred from participating in federal programs. Also, SSA policy sets requirements for state agencies to provide initial and follow-up training. However, state agencies told us they do not always do so. Of the 52 agencies: 14 said they did not consistently perform required checks on consultants either when hiring or annually, and Nine said they did not give consultants some element of required initial or refresher training. We also looked into whether paying consultants per claim rather than an hourly or salary rate—which 19 agencies do—affects the quality of their work. Our analysis of SSA data did not find conclusive evidence of a link between how a state pays consultants and the quality of disability decisions in each state. Employment of Disability Consultants by State How GAO Did This Study We surveyed disability agencies that review claims in the 50 states, District of Columbia, and Puerto Rico. We also analyzed SSA quality assurance data by state, reviewed SSA policies and relevant federal laws and regulations, and interviewed SSA officials and officials from agencies in several states.</div>

Social Security disability benefits are generally intended to help people who cannot work due to a disability. All of the state agencies that review disability claims consult with physicians to evaluate claimants’ medical eligibility.

Concerns have been raised about:

  1. SSA’s oversight of states’ consultants, and
  2. Whether paying contract consultants per claim affects the quality of their work.

SSA cannot be sure that the state agencies’ consultants are qualified and trained to appropriately inform decisions on disability claims.

SSA policy requires state agencies to screen their consultants by checking them against a database of individuals barred from participating in federal programs. Also, SSA policy sets requirements for state agencies to provide initial and follow-up training. However, state agencies told us they do not always do so.

Of the 52 agencies:

  • 14 said they did not consistently perform required checks on consultants either when hiring or annually, and
  • Nine said they did not give consultants some element of required initial or refresher training.

We also looked into whether paying consultants per claim rather than an hourly or salary rate—which 19 agencies do—affects the quality of their work. Our analysis of SSA data did not find conclusive evidence of a link between how a state pays consultants and the quality of disability decisions in each state.

Employment of Disability Consultants by State

We surveyed disability agencies that review claims in the 50 states, District of Columbia, and Puerto Rico. We also analyzed SSA quality assurance data by state, reviewed SSA policies and relevant federal laws and regulations, and interviewed SSA officials and officials from agencies in several states.

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