Social Security will pay outside doctors and medical consulting firms over $200 million in 1986 for hundreds of thousands of medical examinations to help it decide who should be on the disability rolls, but 30 percent to 50 percent of the examinations are not needed, Rep. Ted Weiss (D-N.Y.) charged yesterday.
Weiss told a House Government Operations subcommittee hearing that some of the consultant doctors and medical firms soak Social Security a markup of 237 percent or more on laboratory tests.
The disability program, he said, has spawned a whole new industry of outside medical consultants, many of whom are careless and perfunctory in their examinations.
General Accounting Office officials testified that one firm, Consultative Examinations Inc., is expected to be paid $3.4 million in 1985 for disability consulting work and is headed by a doctor who was the Social Security Administration's chief medical adviser in Chicago at the time he set up the firm. It also operates in Maryland and the District of Columbia, GAO officials said.
Pat Owens, associate commissioner of social security for disability, did not dispute Weiss' contention of abuses but said Social Security is moving vigorously against them. She also questioned whether some practices cited by Weiss are widespread.
In a report requested by Weiss, the GAO said outside consultative exams, used in only a quarter of disability cases a decade ago, were used in 44 percent in 1984.
It said that while abuses and poor administration were being corrected by the Social Security Administration and state disability agencies, 13 percent to 43 percent of the consultative examinations ordered were premature -- done before the rest of the medical file had been properly assembled -- or medically inappropriate.
Weiss said internal reports showed that some doctors and consulting firms charged Social Security far more for lab work, as part of their overall bill, than they had paid laboratories to have it done. Looking at eight large consulting firms and what they charged Social Security for a range of 10 common tests, Weiss said, "In almost every case, the provider added on a huge markup -- some as high as 237 percent -- although there was no independent additional work the doctor does" on the test.
One firm, paying $8 to a laboratory for a chemical test, charged SSA $35. Another firm paid $11.50 for the test but charged SSA $30, according to figures compiled by the committee staff.
A witness, Pearl F. Williams, said her husband went on disability for heart problems in 1974, was called for reexamination in July 1982 and told her, "We were crowded in a small dirty room . . . and herded through the exams like cattle by a couple of smart-aleck kids. The exam lasted less than 10 minutes. They never even checked my heart."
He was removed from the rolls as able to work, but died of a heart attack shortly after.
"After Felix died," said the witness in tears, "I received a certificate from the White House that said they wanted to honor my husband for his service to his country in the Army and the Air Force. I sent it back."