The Politics of Fees for Medical Records

The Politics of Fees for Medical Records

Although I have been a practicing lawyer for 30 years, my focus has been on the judicial process, and I have given little thought to the law-making process. This year that changed, as I have dipped a toe into the legislative pool and would like to share that experience with others. Every WA resident has the power to make their voice heard and contribute to changes in the State laws that we must all follow.

My journey started with a problem faced by my clients, as we try to convince the Social Security Administration that they are disabled. When their appeals reach the hearing level, SSA requires that they produce copies of all their medical records. Under WA state law, medical providers can (and do) charge a $25 administrative fee PLUS $1.12 per page to produce the records. Patients are charged this amount, even if the records are provided in electronic format and there are no actual costs to produce these “pages.”  These copy fees are often $200-$600 per case, and I had one client with so much medical evidence that it cost him $1300 to update it.

Many medical providers use national copy companies to comply with records requests, so these big fees from WA patients end up lining the pockets of out-of-state corporations. Since disabled people are, by definition, unable to work, these fees are being borne by the very people who can least afford them. They have no other source from which to obtain the medical records that they must produce, and these are records that actually belong to the patients. Many law firms, including mine, can front these fees, but the client must ultimately pay for them. The high fees for medical records can make it impossible for applicants without lawyers to prove to SSA that they are disabled. Fed up with this problem, I decided to try to do something about it.

The first step in changing the law is to find a State representative or senator who is willing to take up your cause and introduce a bill. I was fortunate to find a sympathetic ear from Representative Pat Sullivan. Next, make sure that the legislator is aware of all the issues connected with your requested bill. Their staff will then draft a bill for introduction into the appropriate committee. In my case, it is HB1239, and it was introduced through the House Health Care & Wellness Committee. The committees hold public hearings, so make sure that you track your bill and sign up to testify. This is important, as it may be the only opportunity you have to speak with the people who will be deciding whether or not to pass your bill. I found the members of the Health Care & Wellness Committee to be very kind and interested in what I had to say. If your bill gets out of committee, it will be voted on by the Chamber in which it was introduced, in my case the House. If passed, your bill will then go on to the other Chamber, where the committee and floor vote process is repeated.

You can track the status of your bill, and learn more about the committees, at leg.wa.gov.

As of this writing, the Medical Records bill has passed the House and is on its way to the Senate. Hopefully, by the end of this legislative session, we will have a law that gives all disabled people who are pursuing their Social Security disability claims a free copy of their medical records. If you wish to support this particular bill, contact your local State Senator and ask them to vote for it.  And if you see something in your community that needs changing, consider talking with your Representative or Senator about it!

 

 

How to Identify SSA Frauds

SSA’s Fraud Police

You answer a knock on your door, and find two strangers, one of whom is dressed in a police officer’s uniform. They inform you that you may be the victim of Identity Theft, as your ID was found in a den of thieves. Cause for alarm? Yes, but not for the reason you think. If you have applied for Social Security Disability benefits, you are likely the victim of a Fraud Investigation by the CDIU.

The Cooperative Disability Investigations Unit (CDIU) was jointly established by the Social Security Administration (SSA) and the Office of the Inspector General (OIG) in 1998, to prevent fraud. There are currently 28 CDIUs in 24 states, including Washington State. They accept referrals from SSA employees, Administrative Law Judges (ALJ), third parties, and even “anonymous sources.” (www.oig.ssa.gov) If these people want to talk with you, it is because someone suspects that you are trying to defraud the SSA.

The “identity theft ruse” is designed to get invited into your home and to get you chatting with the investigators. Ironically, CDIU agents are allowed to lie to you, in an attempt to prove that you are lying to SSA. They will also talk with your neighbors, friends and family, and often videotape your activities without your knowledge.

Reports generated by the CDIU often contain half-truths and inappropriate conclusions. For example: “W2 stated that Mr. Smith did not appear at all disabled to her.” Unless the anonymous Witness #2 is your doctor, her opinion is irrelevant – and yet your disability claim may be denied based on this CDIU report.

If you have a current claim for SSI or Social Security Disability benefits, and you suspect you have been the target of a CDIU investigation, notify your representative right away. If you are unrepresented, ask SSA for a copy of the CDIU report and all the videotape and interview transcripts. Be prepared to discuss the allegations in the CDIU report with the ALJ at your disability hearing. Depending upon the circumstances, you may also consider speaking with a criminal defense attorney, as these fraud investigations sometimes lead to prison.

Local Disability Attorneys Versus National Ones

Local Disability Attorneys Versus National Ones

When searching for representation for your disability claim, you find yourself faced with many tempting commercial ads for national firms and it’s these firms that also always pop up first on an internet search. Therefore, they must be the way to go right? Maybe. However, maybe not. It’s almost always a better idea to hire locally.

3 Reasons Hiring Local is the Way to Go

It’s true; Social Security claims can be taken care of from any location, but there are real benefits to having a local lawyer represent you:3 Reasons Hiring Local is the Way to Go

1) In person meetings. Working with a local firm, lets you meet face to face with those handling your case early on in the process. This way you can discuss your case in depth before the hearing, which is a huge advantage. When working with a national firm, you often get passed off to the Junior Attorneys or Paralegals and never meet the actual attorney who is handling your case until the day of the hearing. If that happens, you are a mere case number to the attorney, rather than an actual client they have a relationship with and are invested in.

2) Familiarity with local Judges. It can help your case immensely to have a lawyer who knows the area’s judges and their peculiarities. All Social Security cases are first heard by administrative law judges, and they’re all different in how they like to handle cases. When your attorney knows the judge, they’re able to present your case in the way the judge tends to prefer.

3) Familiarity with local SSA staff and doctors. Local attorneys have contacts at the local Social Security offices and with local physicians and specialists. Relationships that your lawyer has established with these people can be very beneficial to your case.

SEE ALSO:

The Appealing Process of Disability

Five Things Social Security Won’t Tell You

How Many Work Credits Do I Need for SSDI Eligibility?

ABLE Act of 2014

ABLE Act of 2014

The ABLE Act (The Achieving a Better Life Experience) Act was introduced in the 113th Congress by a bi-partisan, bicameral set of Congressional Champions. These champions include Senators, Robert Casey Jr. and Richard Burr and Representatives Ander Crenshaw, Chris Van Hollen, Cathy McMorris Rodgers and Pete Sessions. Support has been growing for this Act, which may become law this year.ABLE Act of 2014

Under ABLE, individuals receiving Supplemental Security Income (SSI) and Medicaid could establish tax favored accounts to cover qualified expenses for medical care, housing, schooling and transportation. This would be done by amending Section 529 of the Internal Revenue Service Code of 1986 to create these accounts for individuals with disabilities. This bill would supplement but not supplant, benefits provided through private insurances , the Medicaid program, the SSI program, the beneficiary’s employment and other sources.

The ABLE Act provides individuals with disabilities the same types of flexible savings tools that all other Americans have access to through college savings accounts, individual retirement accounts and the like. This is overall , a good thing.

There is controversy, however, because as it stands, ABLE is really a bill to help the disabled family members/children of middle class and wealthy individuals. These individuals can use ABLE accounts to transfer funds to their disabled family members. Most people on SSI and Medicaid rarely have the ability to accumulate assets on their own in an ABLE account. ABLE could help middle class and wealthy families at the expense of people who apply for SSI in general due to its proposed “pay-fors” that would:

  • -Eliminate the percentage and dollar cap on the user fee that those representing Social Security claimants pay for processing direct payment of fees for representing Social Security claimants.
  • -End the Single Decisionmaker pilot currently used in twenty states.
  • -End the Reconsideration elimination pilot currently used in ten states.

Ending the single decisionmakeer and reconsideration elimination pilots, would make it more difficult to be approved for disability benefits in states affected by ABLE. Some suggest that the pilots be extended to all states and ABLE be part of a comprehensive effort to update the income and resource provisions of SSI and Medicaid. SSI’s provisions have not been updated since SSI came into existence about 40 years ago.

Additionally, eliminating the percentage and dollar caps on the user fee would reduce the net income of those who represent Social Security Claimants which is already a high overhead, low profit margin business. Social Security Representation could become a thing of the past.

Want to learn more about SSI? Check out:

The Appealing Process of Disability

Five Things Social Security Won’t Tell You

Social Security, Disability and Brain Injuries

Social Security, Disability and Brain Injuries

Traumatic brain injury, otherwise known as TBI is an acute injury suffered by the brain. It's causes can be various but the most common are car accidents, falls and fire arms. TBI injuries can range from mild short term amnesia to permanent coma. Some injuries can heal over time while others can be lived with the help of therapy. Still others may just continue to get worse over time.

Social Security, Disability and Brain InjuriesSocial Security for TBI

The Blue Book or Social Security listing of impairments specifically lists TBIs under the cerebral trauma listing. Since TBI can cause a wide range of impairments, the cerebral trauma listing simply refers to the medical guidelines of other impairments. You will automatically be approved for disability for cerebral trauma if your symptoms match the requirements for one of those listings. The listings and requirements are outlined as such:

Epilepsy: All seizure disorders are evaluated under the category of epilepsy. To qualify under this you must have seizures of a particular type and frequency. Your doctor will need to describe a typical seizure and indicate how much of the description is based on their personal observations versus other's.

Central Nervous System Vascular Accident: If you've had one or more strokes you may qualify for disability under this listing. To qualify, you need to have either trouble with speech or communication, and/ or significant and persistent disruption of the use of arms and legs that interferes with using such limbs properly more than three months after the accident.

Organic Mental Disorders: Organic mental disorders are cognitive or emotional changes that result from brain damage. To qualify for this listing, you must show a change in cognitive abilities, disorientation, personality changes or mood changes that limit your daily activities, ability to concentrate or social functioning. Additionally, you may qualify under this listing if your IQ is 15 points less than before your accident or if it is within the severely impaired range on neuropsychological testing.

Ability to Work: Should you not be found eligible by Social Security under any of the above listings, Social Security will evaluate if you are even able to work. Your physical, mental and sensory limitations will be assessed. This assessment will be done using a residual functional capacity form.

Timing: TBIs can be tricky compared to most other illnesses or diseases because of the difficulty of making a long term prognosis. However, Social Security has taken into account the vast variables associated with TBIs. An individual cannot receive benefits until 12 months post injury. However, it is possible to be found disabled at three months post injury. If you're not found disabled at three months post injury, you'll continue to be re-evaluated as evidence of disability is received by Social Security.

See Also:

How Many Work Credits Do I Need for SSDI Eligibility?

Arthritis Sufferers and SSDI Benefits