Summary: 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.
