Articles from prior issues of The Advocate

March/April, 1999

Nade Correspondence

nade
February 24, 1999

The Honorable Nancy L. Johnson,
Chairman
Subcommittee on Human Resources
Committee on Ways and Means
B317 Rayburn House Office Bldg.
Washington DC 20515-6351

Dear Representative Johnson:

Thank you for the opportunity to provide additional comments on HR 631, the SSI Fraud Prevention Act of 1999. As we stated in our earlier comments, we fully support the intent of this legislation. However, we remain mystified by the wording of Section 11, "Annual reviews by State disability determination services of professionals conducting consultative examinations." We previously expressed our concerns regarding the specific language in this section. Although this section has been clarified with the addition of the phrase, ",,,shall include a thorough analysis of the completeness of the examinations performed through such referrals..." we are still unclear about what is meant by "... the extent to which any patterns of abuse have risen in the referral processes." In addition, we are concerned about the impact this section would have on DDS resources.

Federal regulations issued in August 1991 to comply with PL98-460 describe:

1. Standards to be used by State and Federal personnel in determining when a consultative examination should be obtained in connection with disability determinations

2. Standards for the type of referral to be made

3. Procedures to monitor the referral process used

4. Procedures to monitor the product of health professionals to whom cases are referred.

If these regulations are not being followed it is because DDSs lack the resources to do so. Additional legislation will not solve that problem.

Further, current regulations and operating procedures require the DDSs to closely monitor volume providers, those ‘whose billings to the Social Security disability programs are at least $100,000 per year or whose practice is directed primarily towards evaluation examinations rather than treatment or who are one of the top five CE providers in the state dollar volume. Most larger DDSs have thousands of consultants on their CE panels but relatively few volume providers. Monitoring these large volume providers includes on-site visits, claimant surveys and reviews of CE reports. The proposed legislation does not define which CE providers should be monitored. It does not make sense -- nor do DDSs have the resources -- to monitor all sources at the level expected for volume providers. Even smaller DDSs, who might have only a few hundred CE providers, would have extreme difficulty finding the necessary fiscal and manpower resources to conduct extensive monitoring of all CE sources. We believe that any legislation aimed at preventing fraud and abuse should logically define which CE providers are to be evaluated and to what extent. We strongly urge the Committee to draft additional language to Section 11 that would address our concerns in this matter.

Again, thank you for this opportunity to provide these additional comments on HR 631. If you have questions about our position on this legislation we would welcome the opportunity to discuss this further.

Sincerely,

Jeffrey R. Price,
NADE President

Martha A. Marshall
Legislative Committee Chair