The Social Security Administration pays benefits to eligible people who are unable to work due to disability. State agencies review claims for disability benefits, and use "consultants" (physicians) to determine if claimants are medically eligible.
SSA requires state agencies to ensure consultants meet its employment and training standards. While most states we surveyed reported meeting the requirements, several did not. As a result, SSA risks using consultants who are ineligible or not fully trained.
We recommended that SSA take further steps, such as periodic reminders for states, to ensure states properly screen and train consultants.
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.
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.
SSA should take additional steps to ensure states conduct required screenings and training, such as by clarifying its policies and providing periodic reminders. SSA agreed with our recommendations.
Recommendations for Executive Action
|Social Security Administration||The Commissioner of the Social Security Administration should take additional steps to ensure DDSs conduct required SAM checks for consultants, such as policy reminders or periodic checks of compliance. (Recommendation 1)|
|Social Security Administration||The Commissioner of the Social Security Administration should take additional steps to ensure DDSs' compliance with SSA's training policy for consultants, such as reviewing the adequacy of training DDSs provide or sending DDSs periodic reminders about initial and follow-up training policies. (Recommendation 2)|