Puerto Rico Disability Claims Under Fraud Investigation

While Social Security Disability fraud is not a new concept or a topic that has never been raised in the past, widespread fraud across an entire region has never really been an issue that the Social Security Administration has had to deal with – until now.

Allegations of widespread Social Security fraud in Puerto Rico have resulted in an investigation by the SSA's inspector general. Exactly what are these allegations and why did the inspector general need to get involved?

A pharmaceutical plant in Puerto Rico was recently closed and 300 workers were laid off. An astonishing 290 of these workers went on to file for disability benefits. Even more alarming was the fact that all 290 of these workers used the same doctor to file for benefits, according to The Wall Street Journal. Could it possibly be that these laid off workers all lived near the same doctor? Unfortunately not. In fact, the workers lived quite far from the doctor who was handling the disability claims.

To make matters even more concerning is the fact that in 2010, benefits were awarded to more than 63 percent of the initial disability applicants in Puerto Rico – a ratio that is much higher than the rest of the nation. In fact, the rest of the nation has an average approval rate of just over 30 percent for initial Social Security Disability claims. This means Puerto Rico has managed to more than double the approval rate of the nation's average.

To put things into better perspective, out of the top ten U.S. zip codes for disabled workers who are collecting Social Security Disability payments, nine of those zip codes are located in Puerto Rico – not to mention the fact that disability approval rates have more than doubled in recent years within the territory. Beginning to see a pattern?

While it is true that U.S. states and territories are allowed to make their own determinations as to who and who is not awarded disability benefits (as long as those decisions adhere to the SSA's guidelines), Puerto Rico may need to be reminded that SSDI is, after all, a federally-funded program. The territory is not at liberty to make its own guidelines or approve people for Social Security Disability benefits if those individuals are not indeed completely disabled.

When the high approval rates and the alarming issue involving the 290 pharmaceutical plant workers came to light, the Office of the Inspector General realized that an investigation needed to be launched to see if widespread fraud was occurring – regardless of whether that fraud is on part of the doctors, the applicants or even the Social Security staff.

As of now, the investigation into these disability approvals is ongoing and no one yet knows what has caused the alarmingly high approval rates in Puerto Rico. The SSA is, however, determined to get down to the bottom of the matter. If fraud is indeed discovered, we are sure to hear more about who was at fault and the ramifications that those individuals will be facing in the future.