Fraudulent Social Security Medical Exam Reports May Lead to Disability Application Denials

When applying for Social Security Disability benefits, applicants are often required to submit to a consultative medical exam to determine if their impairments prevent them from being able to work.

The exams are performed by government contractors. While contractors do not approve or deny a patient’s application, the consultative exam is often a basis that the Social Security Administration (SSA) uses to make that determination. Social Security pays contractors about $185 for each exam, and they get paid the same whether an applicant qualifies for benefits or not.

A Kansas City, Mo., company has been charged with knowingly submitting false exam reports regarding the medical condition of Social Security Disability applicants.

This may mean that thousands of disability applicants were wrongfully denied benefits. BurnettDriskill, a law firm also in Kansas City, has filed 15 civil lawsuits alleging fraud by Midwest CES, a contractor working on behalf of Social Security.

Lawyers for BurnettDriskill told reporters from KSHB-TV, a Kansas City television station, that the doctors at CES, “simply sign their name to the report, adopt the boiler-plated, canned findings that are in there, which say things like ‘they were able to button and unbutton a shirt,’ (even when an applicant isn’t wearing a shirt with buttons during the exam). They’re just trying to get through as many exams as they can. They don’t particularly care about the claimants, they need to get through them to get paid and move on.”

The lawyers visited Midwest CES for consultative exams, which resulted in reports with similar language about buttoning their clothing or turning doorknobs—even though the exam rooms at the Midwest CES office don’t have doorknobs. As a result, they say, thousands of deserving applicants have been denied benefits. “State records indicate Midwest CES received more than $7 million since 2012 for disability determination services in Missouri,” KSHB reported.

The False Claims Act allows private citizens to file civil lawsuits on behalf of the United States and its taxpayers against those who have defrauded the government.

Officials at CES Midwest deny the allegations presented in the lawsuits. The SSA has declined commenting on the allegations, saying it does not publicly discuss pending litigation.