Here's How 106 NYC First Responders Could Scam Social Security

Flickr/401(K) 2013
Mention "first responder" and people probably picture firefighters, police, EMTs, and ambulance workers. These are the people who run into, fires ... to say nothing of gunfire, explosions, earthquakes, hurricanes, floods, toxic spills, and other disasters, manmade or natural. They are courageous, skilled, and resourceful, and you want to feel nothing but gratitude for what they are willing to do.

So it's painful to hear about the 106 police officers, firefighters, and correctional officers, almost all from New York City, who allegedly scammed Social Security for at least $22 million in undeserved benefits, as Huffington Post reports. This isn't the end: the scam may have involved hundreds more with a total take of $400 million or more. Saddest of all, if prosecutors are correct, many may have used the disaster of September 11, 2001 as the excuse for ill-gotten gains. But all this leaves a big question: How did this crew supposedly pull it off?

According to experts in the Social Security system that spoke with AOL Jobs, fooling Social Security personnel, judges, lawyers, and other professionals can be difficult. The reason this alleged scheme might have worked is because the people involved knew how to play the system.

To understand the difficulty in playing the Social Security Disability Insurance (SSDI) system, which is designed to help people who had been working but are incapacitated, it helps to understand how it works. SSDI is for people who have completely lost the ability to work at any fulltime job. "If you were a race car driver and you can no longer drive a race car because you have a bad back, you can't get into a race car, in order to quality for Social Security disability, you have to prove that you can't be a night watchman," Michael Kalmus, counsel to the West Orange, N.J. law firm Mandelbaum Salsburg, said to AOL Jobs.

In other words, if Social Security determines that someone could do any sort of work, whether a sedentary job or even something as specific as washing cars at a car dealership, that person is not eligible for disability payments. That is different from the disability that many of the alleged fraudsters did qualify for under public pensions, which only require the inability to perform their previous job. Social Security sets a much higher bar. A physical problem would have to be extreme for a person to be eligible for SSDI.

Furthermore, Social Security undertakes extensive reviews of any application for SSDI, requiring the person seeking aid to fill out extensive questionnaires, provide medical evidence, and jump through significant hoops to prove eligible. Information from a doctor -- called a Medical Source Opinion, according to a Social Security official who requested anonymity when speaking with AOL Jobs -- is something that carries a lot of weight. "Unless information is glaringly inconsistent, we have to accept a Medical Source Opinion," says the official. Discounting such evidence requires that the administrative people in Social Security fill out additional paperwork and substantiate their reasons. Even then, a judge can overrule them.

Faking a physical problem that would completely disqualify someone from working would be a big challenge, as there would need to be scans, test results, and other hard evidence. That is why, according to New York County District Attorney's office, the indicted former workers "claimed that they suffered a psychiatric condition that prevented them from working" -- something like post-traumatic stress disorder, anxiety, or depression. There is no physical evidence to provide. Instead, the person in question would have to either work with a doctor who was part of the scheme or be so convincing that the doctor legitimately thought they had a problem.

It's not the Social Security people not doing their job," says Nick Ortiz, a Pensacola, Fla. lawyer and board-certified Social Security disability advocate. "It's them being duped by the evidence. It's easier to fabricate a mental condition and to exaggerate your symptoms than to fake a physical condition." A small group of the indicted people, including a lawyer and a disability consultant, reportedly coached the others in what to say, according to the District Attorney's office.

[Defendants] HALE and ESPOSITO are accused of coaching applicants to falsely describe symptoms of depression and anxiety to doctors they had recruited, in order to build a record of psychiatric treatment over the course of approximately one year. Specifically, they instructed applicants on how to fail memory tests with plausibility, how to dress, and on their demeanor. Almost every application included identical descriptions of the applicants' activities of daily living, such as:

"I nap on and off during the day."
"I have the TV on to keep me company."
"I was a healthy, active, productive person."
"I'm up and down all night long."
"My [family member] is always after me about my grooming."
"I'm unable to perform any type of work activity in or out of the house."

It sounds as though there were doctors also taking part in the scheme.

Although Social Security has a fraud unit that was instrumental in this case, according to the DA, overall it is a small group without the manpower to uncover all problems.

Sadly, this may indicate a trend. "You're starting to see some small clusters [in the country] where it appears there is some sort of collusion between a representative and a physician," Ortiz says. And that could mean more fraud in the system -- and more money scammed from taxpayers.
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