Doctors in Tennessee are being contracted to review claims submitted by Tennesseans for Social Security Disability benefits, with many of them reviewing thousands of cases per year for high payouts. The doctors are hired by the State of Tennessee’s Disability Determination Services, and there are roughly 50 of these doctors who conduct the reviews throughout the year.
One of the doctors, Thomas Thrush, reviews an average of one application per 12 minutes. For the fiscal year (ending June 30,2018), Thrush reviewed a total of 9,088 applications of Tennesseans, which paid him a total of $420,000. Since he was hired to perform this task in 2013, he has made a total of $2.2 million. An average of 80% of the cases Thrush has reviewed have been denied.
Highest denial rates in the country
The State of Tennessee has one of the highest rates in the country for denying applications for Disability benefits. In 2017, 72% of applications were denied. In the same year, the national average for denied claims was 66%.
Investigation into Tennessee disability claims
The Tennessean (part of the USA TODAY news network) launched an investigation into the data surrounding the doctors who review disability claims in Tennessee. The data spanned five-and-a-half years from January 2013 to July 2018. The results of the investigation discovered the following:
- A former medical consultant had his contract terminated after blowing the whistle on doctors reviewing cases too quickly.
- “More than half of all contract physicians outpaced the federal standard of 1.5 cases per hour, and 1 out of every 5 doctors doubled that pace.”
- Seven doctors each billed $1 million apiece between 2013 and 2018.
- “At least two doctors under contract with the state are felons, including Thrush. Two other physicians had their medical licenses placed on probation. Another physician had his license revoked twice in the past 20 years and now works on a restricted license that bars him from treating patients.”
- Doctors hired to be on the staff of the agency took more time to review the cases they were assigned, earning roughly $150,000 per year.
The doctor who blew the whistle on the program
The doctor identified as the whistleblower who lost his contract was identified as Dr. John Mather. Mather went through the official channels to express his concerns about doctors reviewing cases too quickly in order to be paid a high salary. Mather worked as the chief medical officer for Disability programs with the Social Security Administration (SSA). After he retired, he worked as a contract doctor for Tennessee. Mather notified the following entities about his concerns:
- The director of the state disability department
- The commissioner at the time of the Department of Human Services
- The Social Security Administration
- The Office of Inspector General
- The Comptroller of the Treasury auditors
All of this occurred in 2016. In 2017, the director of the state disability department failed to renew Mather’s contract.
Per The Tennessean, “’I don’t think they care about the claimant,’ Mather said of the administrators. ‘They just want to see the cases out. I don’t think they care too much about quality. People who are high producers — they are very happy to have them around.’”
More and more people have begun speaking up about the claims review process, including former and current personnel, because they are concerned about the number of denials. The people speaking up are also requesting an independent investigation into the program.
Representative Jim Cooper issued a statement, claiming the findings were “troubling.” Doctors, he said, “especially those dealing with state and federal funds, should be careful and thorough in their work. Social Security Disability Insurance is a vital program, and we have to keep it strong.”
Errors in denials not likely to be discovered
Even though there is a two-step process in place to catch errors of medical reviewers, most doctors believe that any errors in denying claims will not be discovered. The first step in the process occurs in Nashville, where spot-checks are made on claims that are approved and denied. This part of the process makes sure staff members and contracted doctors have followed the procedures for ruling on claims. The second step of the process is when a portion of the disability claims are reviewed by federal regional offices. According to statistics, the state has averaged a 95.8% quality rating since 2016 when it comes to the quality of case reviews.
Tennessee rejects an incredibly high number of Social Security Disability claims. If you or your loved one was denied benefits, it’s important that you speak with an experienced Disability attorney from Bailey & Greer, PLLC about your case. Call the team at 901-475-7434 to schedule an appointment, or complete our contact form. We maintain office sin Memphis and Jackson, and serve clients throughout West Tennessee.