NORTH KANSAS CITY, Mo. — When additional medical evidence is needed to approve a disability benefits application with the Social Security Administration, the agency requires applicants to get a consultative exam with a doctor.
In the Kansas City region, Midwest CES is one of several contractors working with the government to provide the exams.
Shiron Norah visited one of Midwest CES’s locations in 2018 during her application process. The lifelong Kansas Citian says she can no longer work because of a series of ailments, including carpel tunnel in both wrists, hip surgery, pain in her neck and back, constant migraines and arthritis.
Norah said the doctor at Midwest CES spent less than 10 minutes with her and did not ask her a single question. The doctor’s report cited Norah’s ability to “use her fingers and hands to button and unbutton a shirt,” but Norah says she was not wearing a shirt with buttons during her exam.
While Midwest CES does not approve or deny a patient’s application, the consultative exam helps other administrators make that determination. Norah’s application for $643 in monthly disability payments was denied.
Kyle Sciolaro, an attorney at BurnettDriskill, says he’s found roughly 250 other people in Norah’s shoes. They visited Midwest CES for a consultative exam and subsequent reports had similar language about buttoning their clothing or turning doorknobs - even though the exam rooms at Midwest CES’ North Kansas City office doesn’t have doorknobs.
In a series of civil lawsuits against the Social Security Administration, Midwest CES and doctors conducting exams, Sciolaro and his team allege fraud.
“The path of least resistance for them (the doctors) is simply to sign their name to the report, adopt the boiler-plated, canned findings that are in there, which say things like 'they were able to button and unbutton a shirt,'” Sciolaro explained. “They’re just trying to get through as many exams as they can. They don’t particularly care about the claimants, they need to get through them to get paid and move on.”
The Social Security Administration pays Midwest CES and other contractors roughly $185 per exam. State records indicate Midwest CES received more than $7 million since 2012 for disability determination services in Missouri.
A lawsuit under the False Claims Act allows BurnettDriskill to file a case on behalf of the United States and its taxpayers. It alleges the Midwest CES knowingly submitted false information for payment.
“Every time a false or fraudulent report is injected into the system, it poisons the process and slows everything down,” Derrick Pearce with the law firm explained. “All of that involves tremendous cost to the government.”
President of Midwest CES Jake Johnsen responded to the claims. He calls the exams his company completes “a critical service” that helps prevent fraud. Johnsen pointed out Midwest CES does not know which results will lead to approval or denial of a claim. The government pays contractors like Midwest CES the same whether an applicant qualifies for benefits or not.
“There is zero incentive to provide anything other than honest and fair examinations,” Johnsen wrote in a statement.
He added the company follows standards in accordance with the Social Security Administration and called these lawsuits an attempt to intimidate contractors like Midwest CES to provide exam results “in hopes that applicants will qualify for benefits.”
The Social Security Administration says it does not comment on pending litigation.
Many of the lawsuits remain in the judicial process.
