Congressional Response Report: Failure to Follow Prescribed Treatment
Office Affiliation: The Office of Audit
Audit Report Number: A-01-15-50024
On December 12, 2014, we received a request from the Chairman of the Subcommittee on Social Security, Committee on Ways and Means, to provide information on how SSA ensures beneficiaries follow prescribed treatment.
During an initial claim or continuing disability review (CDR) that would be an allowance or continuation, if evidence shows an individual is not following his/her medical source’s prescribed treatment, the Agency must develop the issue to determine whether this treatment would restore his/her ability to work. There are, however, acceptable reasons for failing to follow prescribed treatment.
From SSA’s records of disability decisions, we obtained a file of all initial claims and CDRs processed in Calendar Year 2012. We reviewed all initial denials and CDR cessations due to failure to follow prescribed treatment. We also reviewed samples of allowed claims and CDR continuances to determine whether any mentioned failure to follow prescribed treatment.
The objective of this report was to answer specific questions from the Subcommittee on Social Security regarding the SSA policy when beneficiaries or claimants fail to follow prescribed treatment.