SSA Management of the Consultative Examination Process

Testimony was given on the GAO review of the Social Security Administration's (SSA) management of the consultative examination process in its disability programs. GAO found that: (1) consultative examinations (CE) are purchased from private medical sources when additional evidence is needed to evaluate disability claims; (2) through the issuance of new policies and procedures, SSA has provided better direction on physician standards and CE reporting requirements and has established more formal CE management and oversight; and (3) despite the progress made, SSA regional offices have found significant rates of premature and inappropriate CE purchasing in several states. GAO also found that: (1) most state CE management plans did not adequately describe how CE appointment scheduling is controlled; (2) there is a need for SSA to establish standards for controlling appointment scheduling and/or examination duration; (3) some volume providers generated reports that did not accurately represent claimants' medical conditions; (4) SSA did not specify how states were to structure their review systems or designate who was to perform the function; and (5) many states were not implementing certain important provisions of their CE management plans. GAO determined that: (1) the lack of systematic regional oversight increased the risk of questionable provider practices and unnecessary CE purchasing; (2) SSA has not established a minimum period which examiners must wait to receive treating source records before ordering CE; and (3) in light of the inconsistency in state CE request review practices and the evidence of premature and inappropriate CE purchases, SSA should conduct a study to determine the effect of medical staff review on CE requests.