Date: June 13, 2008

To: The Commissioner

From: Inspector General

Subject: Quick Response Evaluation: Timeliness of Medical Evidence at Hearing Offices (A-05-08-28106)

The attached final quick response evaluation presents the results of our review. We began this work after you requested that the Office of the Inspector General evaluate and document the extent to which delays in the submission of evidence affects the timeliness of the hearing and appeal process. Our objectives were to assess (1) the Social Security Administration's procedures for monitoring the timeliness of medical evidence provided to hearing offices, (2) the validity of the data used in this monitoring, and (3) based on the data, the extent of problems with untimely medical evidence.

If you wish to discuss the final report, please call me or have your staff contact Steven L. Schaeffer, Assistant Inspector General for Audit, at (410) 965-9700.

Patrick P. O'Carroll, Jr.

QUICK RESPONSE
EVALUATION

Timeliness of Medical Evidence
at Hearing Offices

A-05-08-28106

June 2008

Mission

By conducting independent and objective audits, evaluations and investigations, we inspire public confidence in the integrity and security of SSA's programs and operations and protect them against fraud, waste and abuse. We provide timely, useful and reliable information and advice to Administration officials, Congress and the public.

Authority

The Inspector General Act created independent audit and investigative units, called the Office of Inspector General (OIG). The mission of the OIG, as spelled out in the Act, is to:

Conduct and supervise independent and objective audits and investigations relating to agency programs and operations.
Promote economy, effectiveness, and efficiency within the agency.
Prevent and detect fraud, waste, and abuse in agency programs and operations.
Review and make recommendations regarding existing and proposed legislation and regulations relating to agency programs and operations.
Keep the agency head and the Congress fully and currently informed of problems in agency programs and operations.

To ensure objectivity, the IG Act empowers the IG with:

Independence to determine what reviews to perform.
Access to all information necessary for the reviews.
Authority to publish findings and recommendations based on the reviews.

Vision

We strive for continual improvement in SSA's programs, operations and management by proactively seeking new ways to prevent and deter fraud, waste and abuse. We commit to integrity and excellence by supporting an environment that provides a valuable public service while encouraging employee development and retention and fostering diversity and innovation.

Executive Summary
OBJECTIVE

Our objectives were to assess (1) the Social Security Administration's (SSA) procedures for monitoring the timeliness of medical evidence provided to hearing offices, (2) the validity of the data used in this monitoring, and (3) based on the data, the extent of problems with untimely medical evidence.

BACKGROUND

On October 29, 2007, SSA issued a notice of proposed rulemaking (NPRM) that stated "Our program experience has convinced us that the late submission of evidence to the [Administrative Law Judge] significantly impedes our ability to issue hearing decisions in a timely manner." To remedy this situation, the NPRM listed a number of potential changes to the appellate process, including (1) requiring at least 75 days' notice for hearings and (2) requiring the submission of evidence at least 5 days before the hearing to ensure the Administrative Law Judge has time to review the evidence. Subsequent to the NPRM, the Commissioner requested that the Office of the Inspector General evaluate and document the extent to which delays in the submission of evidence affects the timeliness of the hearing and appeal process.

RESULTS OF REVIEW

We determined that the Case Processing and Management System (CPMS) information being used by the Office of Disability Adjudication and Review (ODAR) to monitor the timeliness of medical evidence did not indicate the late submission of medical evidence before hearings was a significant issue at hearing offices. ODAR managers identified two points in the hearing process affected by the late submission of medical evidence by claimants and their representatives before the hearing: hearing postponements (where the hearing is scheduled for a later date) and post-hearing development (where evidence is reviewed after the hearing). When we reviewed these two points of the hearing process, we found that about 0.2 percent of hearings were postponed annually as a result of late medical evidence and about 1.8 percent of the workload currently in-process was significantly delayed after the hearing due to late medical evidence.

When we reviewed all medical evidence delays in the hearing process, in addition to claimant-related issues before the hearing, we found that as much as 7.2 percent of the workload currently in-process was significantly delayed because of late medical evidence. However, since the majority of these medical evidence issues occur before the claimant's hearing is scheduled, they are neither directly associated with the medical evidence problems noted in the October 2007 NPRM nor likely to be remedied by the hearing process changes proposed in the notice.

Table of Contents
Page
INTRODUCTION 1
RESULTS OF REVIEW 3
DELAYS IN MEDICAL EVIDENCE 3
HEARING POSTPONEMENTS 3
POST-HEARING DEVELOPMENT 6
PRE-HEARING DEVELOPMENT 9
MATTERS FOR CONSIDERATION 11

APPENDICES
APPENDIX A - Acronyms
APPENDIX B - Notice of Proposed Rulemaking
APPENDIX C - Scope and Methodology
APPENDIX D - Hearing Office Process Flow Diagram
APPENDIX E - New Evidence Postponement Code Activity
APPENDIX F - No Status Change Report
APPENDIX G - Prior Audit Work on Pending Claims
APPENDIX H - Benchmarks for Quality Case Processing
APPENDIX I - OIG Contacts and Staff Acknowledgments

Introduction
OBJECTIVE

Our objectives were to assess (1) the Social Security Administration's (SSA) procedures for monitoring the timeliness of medical evidence provided to hearing offices, (2) the validity of the data used in this monitoring, and (3) based on the data, the extent of problems with untimely medical evidence.

BACKGROUND

The hearing process begins after an individual is denied benefits at the initial and reconsideration levels at a State disability determination services (DDS) office. The next step in the appeals process is a hearing before an administrative law judge (ALJ). Individual hearings are held by 1 of the Office of Disability Adjudication and Review's (ODAR) 141 hearing offices located nationwide.

Hearing offices may request two types of medical evidence as part of their review of a disability case: medical evidence of record (MER) and consultative examinations (CE). MERs are copies of existing medical evidence, whereas CEs supplement MER obtained from claimants' treating sources. CEs may include medical and psychological examinations, x-rays, and laboratory tests. Hearing offices may also call in medical and vocational experts in cases where the ALJ can "...gain information which will help him or her evaluate the medical evidence in a case...." According to ODAR's procedures, hearing offices can request medical evidence from (1) the claimant, (2) the State DDS, and/or (3) the treating source or other medical source.

Claimants and their representatives are also requested to provide relevant medical evidence to the ALJ before the hearing. According to SSA's policy, "The claimant is responsible for providing evidence to support his or her claim. If the claimant does not provide medical or other evidence the [ALJ] needs and asks for, the ALJ will generally make a decision based on the evidence in the record, including evidence the ALJ has obtained directly." ODAR uses the Case Processing and Management System (CPMS), a web-based tracking system, to electronically control and process hearing cases. Through CPMS, ODAR management can monitor the hearings workload. The CPMS management reports are available at the local (hearing office), regional, and national levels.

Proposed Changes to the Medical Evidence Process

On October 29, 2007, SSA issued a notice of proposed rulemaking (NPRM) regarding Amendments to the Administrative Law Judge, Appeals Council, and Decision Review Board Appeals Levels. The NPRM noted the following

Our program experience has convinced us that the late submission of evidence to the ALJ significantly impedes our ability to issue hearing decisions in a timely manner. When new and voluminous medical evidence is presented at the hearing or shortly before the hearing, the ALJ and any other person who will be participating in the hearing, such as a medical or vocational expert, do not have the time needed to review the record and adequately prepare for the hearing. We often must reschedule the hearing, which not only delays the decision on that case, but also delays the hearings of other individuals.

To remedy this situation, the NPRM listed a number of changes SSA proposed to the appellate process, including (1) requiring at least 75 days' notice for hearings and (2) requiring the submission of evidence at least 5 days before the hearing to ensure the ALJ has time to review the evidence (see Appendix B). ODAR management explained that the additional notice period before the hearing would provide the claimants and their representatives more time to obtain the required medical evidence.

Subsequent to the NPRM, the Commissioner requested that the Office of the Inspector General (OIG) evaluate and document the extent to which delays in the submission of evidence affects the timeliness of the hearing and appeal process. To meet our objectives, we discussed the hearing process and medical evidence issues with ODAR management and staff, examined policies and procedures related to the timeliness of medical evidence, obtained CPMS management reports, and reviewed prior work in this area. We provide additional information on our review approach in Appendix C.

Results of Review
We determined that the CPMS information used by ODAR to monitor the timeliness of medical evidence did not indicate that the late submission of medical evidence before hearings was a significant issue at hearing offices. ODAR managers identified two points in the hearing process affected by the late submission of medical evidence by claimants and their representatives prior to the hearing: hearings postponements (where the hearing is scheduled for a later date) and post-hearing development (where evidence is reviewed after the hearing). When we reviewed these two points of the hearing process, we found that about 0.2 percent of hearings were postponed annually as a result of late medical evidence and about 1.8 percent of the workload currently in-process was significantly delayed after the hearing due to late medical evidence. In addition, ODAR management stated that hearings postponement data for late medical evidence were incomplete since hearing offices may not have been coding cases properly. As a result, ODAR issued new guidance to the hearing offices. Moreover, while the CPMS data on post-hearing development were more accurate, CPMS did not specifically monitor the Chief ALJ's timeliness goals for medical evidence. Finally, when we reviewed all medical evidence delays in the hearing process, in addition to claimant-related issues before the hearing, we found that as much as 7.2 percent of the workload currently in-process was significantly delayed because of late medical evidence.

DELAYS IN MEDICAL EVIDENCE

In our discussions with ODAR management, we were informed that hearing delays associated with late medical evidence from claimants and their representatives usually resulted in (1) postponements of hearings and/or (2) post-hearing development workloads. For example, an ALJ can postpone a hearing when the claimant or claimant's representative provides new medical evidence on the day of the hearing. In addition, an ALJ can continue with the hearing when medical evidence is provided late in the process and assess the new evidence after the hearing, a process called "post-hearing development." (See Appendix D for an explanation of the various steps in the hearing process.) To better understand these delays, we asked management for any reports or analysis indicating late medical evidence led to significant postponements and/or post-hearing development workloads. We discuss each of these issues below.

HEARING POSTPONEMENTS

CPMS information indicates that about 0.2 percent of all hearing cases processed in Fiscal Year (FY) 2007 were postponed because of late evidence. ODAR management has stated the hearing offices were probably not properly coding all postponed cases associated with late evidence, which led to the issuance of new guidance. Even with this new guidance, we have not seen a significant increase in the number of cases postponed because of late evidence.

Postponement Codes

ODAR uses the CPMS Auxiliary Monthly Activity Report (AUX MAR) to monitor the different types of postponements in the hearing offices. Per the AUX MAR, we found that 956 hearings were postponed in FY 2007 under the "new evidence" (NE) code, which is used to indicate a case has been postponed as a result of new evidence brought to the hearing or to obtain additional evidence (see Table 1). These
956 hearings represent about 0.2 percent of the approximately 548,000 cases decided in FY 2007.

Table 1: New Evidence Postponements by SSA Region (FY 2007)
Region Number of Postponements Percent of Total
Atlanta 117 12.2
Boston 31 3.2
Chicago 145 15.2
Dallas 182 19.0
Denver 39 4.1
Kansas City 36 3.8
New York 133 13.9
Philadelphia 46 4.8
San Francisco 199 20.8
Seattle 28 2.9
Total 956 100.0
Note: May not add to 100 percent due to rounding.

New Guidance

ODAR representatives stated that it is possible the NE postponement code is not being properly used at hearing offices and therefore the OIG should be cautious about relying on this low figure. As a result of our review, on January 10, 2008, ODAR management sent a reminder to hearing office managers on the proper use of the NE code. In this guidance, ODAR stated, in part,

We want to ensure that this code is consistently used nationally. Please remind your hearing office management teams, that whenever a case is postponed or continued as a result of new evidence being brought to the hearing or is postponed or continued to obtain additional evidence, the NE code should be used. While this code has been available for some time, we would ask that the hearing office management teams ensure that the contract reporters are reminded that this is the appropriate code for any postponements or continuances that occur as a result of new evidence brought to the hearing or as a result of postponements or continuances to obtain additional evidence.

When we noted CPMS does not actually use the term "NE" when information is being input, ODAR staff agreed that the January 2008 guidance could be clearer and may need to be reissued. While the NE code is a CPMS data element, the hearing office staff inputting the postponement information into CPMS does not see this code but instead use a drop down menu to choose the reason for the postponements.

Recent Use of the Postponement Code

To date, the issuance of new guidance has not led to an overall increase in the number of cases coded as postponed because of late evidence. The use of the NE postponement code averaged 80 hearing cases per month in FY 2007, and we found that, between February 19 and March 19, 2008, 83 hearings were postponed. As a result, we do not see evidence the number of postponed cases will rise above 1 percent of the FY 2008 goal for ALJ dispositions. ODAR staff concurred that the NE postponement code data did not change significantly after the new guidance was issued.

Review of October 2007 Postponements

To determine how a postponement will affect the overall timeliness of a hearing, we reviewed a sample of 15 claimants whose hearings were postponed in October 2007 because new evidence was received at the hearing or to obtain additional evidence. As of the end of March, we found that 14 of the 15 cases had a hearing, were scheduled for a hearing, or were disposed of without a hearing. These 14 cases were delayed an average of 15 weeks from the postponement date to the case disposition. As of the end of April 2008, the remaining case had yet to be scheduled for a hearing.

POST-HEARING DEVELOPMENT

CPMS information indicates that approximately 1.8 percent of all hearings currently in-process were recorded as "untimely" in the post-hearing development status codes. We also found that other guidelines on medical evidence were not clearly integrated into the CPMS management reports, which may preclude ODAR managers from holding hearing offices accountable for timely dispositions.

No Status Change Report

ODAR headquarters, regional, and hearing offices use the No Status Change report to monitor the hearing process and ensure pending claims are processed timely (see Table 2). According to the CPMS No Status Change report, 2,135 hearings in the No Status Change report for January 8, 2008 were "untimely," or exceeded the 90-day benchmark, while in the Post-Hearing Development status code. This represents about 0.7 percent of approximately 326,000 hearings currently in-process. , We expanded the definition of this post-hearing work to include untimely ALJ Review Post-Hearing, a 30-day step where the ALJ reviews the accumulated medical evidence before making a decision. This represented another 3,726 claims as of January 8, 2008. These additional claims represent about 1.1 percent of the approximately 326,000 hearings currently in-process. When the two status codes are combined, we found that about 1.8 percent of the workload currently in-process was in some form of post-hearing development status. It is possible a different definition of "untimely" would increase the number of cases in this category. However, we limited our definitions to those being used by SSA management.

As part of CPMS, hearing office employees assign a status code to each claim as it moves through the process. The status code identifies the claim's processing stage and location. While CPMS uses about 40 status codes to track and process pending claims in the hearing offices, the No Status Change report tracks claims in 12 specific status codes (see Table 2). For example, a case in the Post-Hearing Development status code must be moved to the next status code within 90 days or the case will appear on the No Status Change report. Our June 2006 audit found the No Status Change report to be accurate.

Table 2: 12 Benchmarks in No Status Change Report (Chronological Order)
Status Codes Tracked by the
No Status Change Report ODAR Benchmark
(Days) Explanation of Benchmark Step
1. Master Docket 30 Claim information input to CPMS.
2. Work Up 25 Claim assigned and being prepared for review.
3. Pre-Hearing Development 90 Requested additional information prior to hearing.
4. ALJ Review Pre-Hearing 10 ALJ reviewing claim prior to hearing.
5. Ready to Schedule 60 Claim work-up and development completed.
6. Post-Hearing Development 90 ALJ requested more information after hearing.
7. ALJ Review Post-Hearing 30 ALJ examining record before writing decision.
8. Unassigned Writing 30 Claim waiting to be assigned to a writer.
9. Decision Writer Personal
Computer 15 Writer using a personal computer to draft decision.
10. Edit 15 ALJ editing final written decision.
11. Sign 7 Decision ready for ALJ's signature.
12. Mail 7 Decision signed and ready for release.
Note: See Appendix D for more specific information on the hearing process.

Additional Guidance on Post-Hearing Development Timeliness

ODAR has provided hearing offices with inconsistent guidelines for the timely processing of medical evidence (see Table 3). For instance, in 2007, the Office of the Chief Administrative Law Judge (OCALJ) established Benchmarks for Quality Case Processing, which provides guidance on the maximum time a case should remain in a category absent good cause (see Appendix H for the OCALJ codes). For medical evidence, the Benchmarks for Quality Case Processing allows 21 days to obtain MER from treating sources and 84 days to obtain a CE from treating sources during both the pre- and post-hearings development process. Together, the MER and CE steps under the Benchmarks for Quality Case Processing allows 105 days, compared to 90 days for this step in the No Status Change report.

Although it appeared ODAR management was treating the Benchmarks for Quality Case Processing as the preferred standard for the hearing offices, we did not see evidence CPMS management reports had been arranged to highlight delays in meeting these two medical evidence goals. ODAR management concurred that the specific benchmarks were not being tracked via a CPMS management report.

ODAR has also established criteria for processing medical evidence in the HALLEX Manual. For instance, the HALLEX Manual performance standard request for MER is 30 days, depending on the availability of the evidence. Another 30 days is allowed to obtain the CE. While the HALLEX guidance notes that diaries should be set up in the system to ensure the evidence gathering process is timely, we did not see evidence CPMS management reports had been arranged to highlight such delays.

Table 3: ODAR's Medical Evidence Timeliness Criteria

Criteria
Obtaining MER
Obtaining a CE Medical Evidence Goal
Benchmarks for Quality Case Processing 21 days 84 days 105 days
No Status Change Report 90 days 90 days
HALLEX 30 days 30 days 60 days

PRE-HEARING DEVELOPMENT

While our report has focused on late medical evidence provided by the claimant and/or claimant's representative before the hearing and the attempts to obtain that evidence after the hearing, medical evidence can be delayed in other parts of the hearing process, such as the periods covered by the Pre-Hearing Development and ALJ Review Pre-Hearing status codes (see Appendix F). The No Status Change report for January 8, 2008 indicates that claims would be considered untimely if they exceeded 90 days under the Pre-Hearing Development status code and 10 days under the ALJ Review Pre-Hearing status code. We found that approximately 1.2 percent of the workload currently in-process was untimely under the Pre-Hearing Development status code and another 4.2 percent of the workload currently in-process was untimely under the ALJ Review Pre-Hearing status code (see Appendix F). Together, approximately 5.4 percent of the workload currently in-process was untimely within these two status codes.

Our March 2007 audit stated the ALJs we interviewed indicated delays under the ALJ Review Pre-Hearing status code related to some claims containing a significant amount of evidence to examine, which caused them to exceed the 10 day benchmark. ALJs also expressed a concern that they had too many cases on their dockets and therefore they were constantly balancing the quality of the decision with the Agency's goal for average processing time.

Since these medical evidence issues occur before the claimant's hearing is scheduled, they are neither directly associated with the medical evidence problems noted in the October 2007 NPRM nor likely to be remedied by increasing the notification period for a hearing to at least 75 days. However, these additional medical evidence bottlenecks show the importance of timely medical evidence throughout the entire hearing process. These pre-hearing medical evidence issues, combined with the post-hearing medical evidence issues, indicate that as much as 7.2 percent of cases currently in-process were significantly delayed.

Matters for Consideration
During our review, we found that ODAR used CPMS reports to monitor the timeliness of medical evidence provided to hearing offices. However, in our review of CPMS management reports, we did not find any evidence that the late submission of medical evidence provided by claimants and their representatives before hearings was a significant issue at hearing offices. When we reviewed the two points in the hearing process identified by ODAR management, we found that about 0.2 percent of hearings were postponed annually and about 1.8 percent of the workload currently in-process was significantly delayed after the hearing due to late medical evidence.

Moreover, our review of the CPMS information found the postponement data may have been incomplete, whereas the No Status Change report data were more reliable but inconsistent with some of ODAR's stated goals, such as the OCALJ's timeliness goals regarding medical evidence. As a result, it is possible that a different definition of "untimely" in CPMS would change the number of significantly delayed hearings. However, we limited our analysis to the CPMS "untimely" benchmarks being used by ODAR management.

Finally, when we reviewed medical evidence delays beyond issues related to the role of the claimant before the hearing, we found that as much as 7.2 percent of the hearings workload currently in-process was significantly delayed because of late medical evidence. However, this expanded definition of untimely cases is not directly associated with the medical evidence problems noted in the October 2007 NPRM and therefore most of these delays are not likely to be remedied by increasing the notification period for a hearing to at least 75 days.

Appendices

Appendix A
Acronyms

AA Attorney Advisor
ALJ Administrative Law Judge
AUX MAR Auxiliary Monthly Activity Report
CE Consultative Examination
CPMS Case Processing and Management System
DDS Disability Determination Services
FY Fiscal Year
HALLEX Hearings, Appeals and Litigation Law
MER Medical Evidence of Record
NE New Evidence
NPRM Notice of Proposed Rulemaking
OCALJ Office of the Chief Administrative Law Judge
ODAR Office of Disability Adjudication and Review
OIG Office of the Inspector General
OTR On-The-Record
PA Paralegal
SAA Senior Attorney Advisor
SSA Social Security Administration
UNWK Unassigned Workup

Appendix B
Notice of Proposed Rulemaking

On October 29, 2007, the Social Security Administration (SSA) issued a notice of proposed rulemaking regarding Amendments to the Administrative Law Judge, Appeals Council, and Decision Review Board Appeals Levels. The following table summarizes some of the changes SSA proposed to the hearings and appeals provisions regarding the timeliness of medical evidence.

Table B-1: Comparison of Current and Proposed Policy

Topic Current Policy
(Outside the Boston Region)

Proposed Policy

Three Levels of Disability Appeals

Submitting Evidence
o ALJ Hearing--Notify claimant at least 20 days prior to hearing

o ALJ accepts evidence up to and including day of hearing

o In proceedings on remand from the Appeals Council or a Federal court, ALJ accepts evidence relating to period following first ALJ decision

o ALJ Hearing--Notify claimant no later than 75 days prior to hearing1

o ALJ will accept evidence submitted no later than 5 business days before the hearing1

o In proceedings on remand from the Review Board or a Federal court, ALJ will not accept evidence relating to period following first ALJ decision2

Note 1: The October 2007 NPRM provisions to provide at least 75 days' notice of the hearing and require the submission of evidence at least 5 days before the hearing (subject to certain exceptions) were based on similar rules included in the Disability Service Improvement regulations published in the Federal Register on March 31, 2006 (71 Fed. Reg. 16424) and implemented in the Boston Region in August 2006.

Note 2: This proposal was not a part of the DSI regulations published in the Federal Register on March 31, 2006.

Appendix C
Scope and Methodology
To accomplish our objectives, we:

Reviewed applicable laws, regulations and Social Security Administration (SSA) policies including sections of SSA's Hearings, Appeals, and Litigation Law Manual and other Office of Disability Adjudication and Review's (ODAR) guidance, policies and procedures.

Reviewed prior Office of the Inspector General (OIG) and Government Accountability Office audit reports.

Reviewed SSA's Notice of Proposed Rulemaking, Amendments to the Administrative Law Judge, Appeals Council, and Decision Review Board Appeals Levels, 72 Federal Register 61218, October 29, 2007.

Interviewed SSA's representatives from ODAR's Offices of the Chief Administrative Law Judge and Management to learn more about the role of evidence in the hearing process, identify potential bottlenecks, and obtain the related management information.

Obtained and evaluated Case Processing and Management System (CPMS) medical evidence data and reports from ODAR and SSA's Office of Information Systems, including the Auxiliary Monthly Activity Report, Workload Summary by Status Report, and No Status Change report.

Reviewed a sample of 15 new evidence postponement cases for October 2007 in the CPMS to determine the status of postponed cases.

Because of time constraints, we did not review the internal controls related to SSA's management and oversight of medical evidence nor assess data reliability of the medical evidence data in CPMS or other management information systems. However, where possible we relied on prior audit work in this area. For example, the CMPS No Status Change report was previously audited by the OIG and found to be reliable. The entity audited was SSA's ODAR under the Deputy Commissioner for ODAR. We performed our review in Chicago, Illinois, between January and March 2008 in accordance with the Quality Standards for Federal Offices of Inspector General dated October 2003.

Appendix D
Hearing Office Process Flow Diagram

Appendix E
New Evidence Postponement Code Activity

Appendix F
No Status Change Report
Status Codes Tracked By the No Status Change Report
Benchmark
Explanation of Benchmark Step
Number of Cases in Status Code
Percent of
In-Process Workload1 in Status Code
Status Codes Tracked By the No Status Change Report Percent of
In-Process
Workload2 Considered Untimely
1. Master Docket 30 days Claim information input to the Case Processing and Management System. 32,731 10.0 15,877 4.9
2. Work Up 25 days Claim assigned and being prepared for review. 18,407 5.6 7,895 2.4
3. Pre-Hearing Development 90 days Requested additional information before hearing. 28,313 8.7 3,759 1.2
4. Administrative Law Judge (ALJ) Review Pre-Hearing 10 days ALJ reviewing claim before hearing. 18,707 5.7 13,557 4.2
5. Ready to Schedule 60 days Claim work-up and development completed. 54,699 16.8 19,110 5.9
6. Post-Hearing Development 90 days ALJ requested more information after hearing. 17,091 5.2 2,135 0.7

Status Codes Tracked By the No Status Change Report
Benchmark
Explanation of Benchmark Step
Number of Cases in Status Code
Percent of
In-Process Workload1 in Status Code
Status Codes Tracked By the No Status Change Report Percent of
In-Process
Workload1 Considered Untimely
7. ALJ Review Post-Hearing 30 days ALJ examining record before writing decision. 9,091 2.8 3,726 1.1
8. Unassigned Writing 30 days Claim waiting to be assigned to a writer. 14,016 4.3 5,779 1.8
9. Decision Writer Personal Computer 15 days Writer using a personal computer to draft decision. 9,054 2.8 2,521 0.8
10. Edit 15 days ALJ editing final written decision. 3,240 1.0 871 0.3
11. Sign 7 days Decision ready for ALJ's signature. 2,581 0.8 581 0.2
12. Mail 7 days Decision signed and ready for release. 2089 0.6 242 0.1
Total2 210,019 64.4 76,053 23.3

Note 1: We used CPMS' January 8, 2008 Workload Summary by Status Report, which indicated about 756,000 hearings were in the backlog. We removed claims that were in the Unworked status code because the hearing offices were taking no action on these cases (see Appendix G). We calculated the "in-process" workload to be approximately 326,000 cases. While there are several ways to define the "in-process" workload, we attempted to focus on those cases being worked by someone in a hearing office.

Note 2: The total number of cases in the No Status Change report above do not add to the 326,000 hearing cases, our calculated "in-process" workload, since not all status codes are tracked on the No Status Change report. For example, hearings in Scheduled status are not tracked on the No Status Change report.

Appendix G
Prior Audit Work on Pending Claims
In our March 2007 audit of Management's Use of Workload Status Reports at Hearing Offices, we assessed the effectiveness of the benchmarks used in the Case Processing and Management System's (CPMS) No Status Change report to identify bottlenecks in the Social Security Administration's (SSA) hearing process. As part of this review, we noted that, of the 725,000 pending claims, 419,000 were located in 2 status codes that did not have benchmarks (see Figure G-1), while 306,000 claims had benchmarks and were being tracked by the No Status Change report. About 48 percent of the pending claims were in the Unassigned Workup (UNWK) status code. The UNWK status code indicates a claim was entered into the hearing office's Master Docket, but the claim is "inactive" and awaiting processing. The remaining 10 percent of the pending claims were located in the Scheduled status code. The Scheduled status code indicates the claim was scheduled for a hearing and is awaiting a hearing date.

Figure G-1: Distribution of ODAR's Pending Workload
(as of June 2006)

We also noted that previous reports indicated that receipts outpaced hearing office dispositions, resulting in an increasing pending workload and worsening processing times. ODAR's hearing offices have been unable to process all the incoming workload. Consequently, the number of pending claims under the UNWK status code has been increasing. Claims continue to age while being held in the "inactive" UNWK status code. Hearing office managers use the CPMS Pending Claims management report to

track the claims while they are in the UNWK status code. Hearing office staff move the pending claims out of the UNWK status code, and place them into the hearing process, based on the "Request for Hearing" date. Therefore, the oldest claims are processed before the newer claims, unless the claim is labeled as a Critical Case. Critical Cases are a priority and are processed first.

Appendix H
Benchmarks for Quality Case Processing
The benchmarks published at the Office of the Chief Administrative Law Judge web site during 2007 provided guidance on the maximum time cases should remain in each category absent good cause.

Case Processing and Management System Code
Benchmark
(Calendar Days)

Comments
Master Docket 21 Receipt of claim file through auto establish in Case Processing and Management System
PRE/POST
Prior files 28 Requests for prior files
(diary for 28 days)
PRE/POST
Medical Evidence of Record 21 Requests for Treating Sources
(diary for 10 days for follow up)
PRE/POST
Consultative
Examinations (CE) 21/63 21 days to be sure the CE is scheduled
63 days to be sure the CE report is
received at the hearing office
TEMP 42 Cases transferred to other hearing offices for case preparation or decision drafting should be completed and returned to the original hearing office within 42 days
Decision Writer Review
(Unpulled File Review) 7 Pre-hearing Review (Administrative Law Judge [ALJ]/Senior Attorney Advisor [SAA]/Attorney Advisor [AA])/Paralegal [PA])
Workup 7 Case Workup
(assembly/development/analysis)
ALJ Review Pre-Hearing1 7 ALJ Review (Pre-scheduling)
ALJ Review Post-Hearing1 7 ALJ Review (Post-hearing)
ALJ Dictating Decision
ALJ Writing Decision on Personal Computer
ALJ Writer Speech Recognition 14 ALJ Drafting Decision
Decision Writer Dictating Decision
Decision Writer Writing Decision on personal computer
Decision Writer Speech Recognition 7 Pre-hearing Review (ALJ/SAA/AA/PA)
EDIT 7 ALJ/SAA/AA/PA Editing Decision

Case Processing and Management System Code
Benchmark
(Calendar Days)

Comments
Typist Corrections
(CORR) 7 Typographical corrections to be corrected
on ALJ decision
SIGN1 1 Case in the ALJ's office waiting final
review, ALJ Verification Input Database, and signature
MAIL 1 Awaiting mailing of ALJ decision

Note 1: ALJ on travel docket/unavailable, timeframe begins upon return to hearing office.

Appendix I
OIG Contacts and Staff Acknowledgments
OIG Contacts
Walter Bayer, Director, Chicago Audit Division (312) 353-0331
Annette Dunn, Audit Manager, Chicago Office (312) 886-4160
Acknowledgments
In addition to those named above:
Linda Smid, Auditor
Wai Ho Yung, Auditor

For additional copies of this report, please visit our web site at www.socialsecurity.gov/oig or contact the Office of the Inspector General's Public Affairs Specialist at (410) 965-3218. Refer to Common Identification Number A-05-08-28106.

Overview of the Office of the Inspector General
The Office of the Inspector General (OIG) is comprised of an Office of Audit (OA), Office of Investigations (OI), Office of the Chief Counsel to the Inspector General (OCCIG), Office of External Relations (OER), and Office of Technology and Resource Management (OTRM). To ensure compliance with policies and procedures, internal controls, and professional standards, the OIG also has a comprehensive Professional Responsibility and Quality Assurance program.

Office of Audit
OA conducts financial and performance audits of the Social Security Administration's (SSA) programs and operations and makes recommendations to ensure program objectives are achieved effectively and efficiently. Financial audits assess whether SSA's financial statements fairly present SSA's financial position, results of operations, and cash flow. Performance audits review the economy, efficiency, and effectiveness of SSA's programs and operations. OA also conducts short-term management reviews and program evaluations on issues of concern to SSA, Congress, and the general public.

Office of Investigations
OI conducts investigations related to fraud, waste, abuse, and mismanagement in SSA programs and operations. This includes wrongdoing by applicants, beneficiaries, contractors, third parties, or SSA employees performing their official duties. This office serves as liaison to the Department of Justice on all matters relating to the investigation of SSA programs and personnel. OI also conducts joint investigations with other Federal, State, and local law enforcement agencies.

Office of the Counsel to the Inspector General
OCIG provides independent legal advice and counsel to the IG on various matters, including statutes, regulations, legislation, and policy directives. OCIG also advises the IG on investigative procedures and techniques, as well as on legal implications and conclusions to be drawn from audit and investigative material. Also, OCIG administers the Civil Monetary Penalty program.

Office of External Relations
OER manages OIG's external and public affairs programs, and serves as the principal advisor on news releases and in providing information to the various news reporting services. OER develops OIG's media and public information policies, directs OIG's external and public affairs programs, and serves as the primary contact for those seeking information about OIG. OER prepares OIG publications, speeches, and presentations to internal and external organizations, and responds to Congressional correspondence.

Office of Technology and Resource Management
OTRM supports OIG by providing information management and systems security. OTRM also coordinates OIG's budget, procurement, telecommunications, facilities, and human resources. In addition, OTRM is the focal point for OIG's strategic planning function, and the development and monitoring of performance measures. In addition, OTRM receives and assigns for action allegations of criminal and administrative violations of Social Security laws, identifies fugitives receiving benefit payments from SSA, and provides technological assistance to investigations.