I-1-3-9.Reporting Fraud or Criminal Violations by Employees, Contractors, Claimants, or Other Members of the Public
Last Update: 5/13/14 (Transmittal I-1-74)
Any Office of Disability Adjudication and Review (ODAR) employee who suspects that a Social Security Administration (SSA) employee, state agency employee, contractor, claimant, or other member of the public is violating the Social Security Act or other Federal law, or is perpetrating fraud, must refer the matter to the Office of the Inspector General (OIG).
If the individual is an appointed representative, see the instructions in Hearings, Appeals and Litigation Law (HALLEX) manual I-1-3-6.
If the suspected criminal violation is related to an issue being adjudicated, see the referral instructions in I-1-3-18 and I-1-3-21. If the suspected criminal violation comes to the attention of an administrative law judge (ALJ) during testimony given at hearing, and the suspected criminal violation is unrelated to the merits of the case, the ALJ will limit the hearing to the issues in the notice of hearing and will avoid initiating further inquiry during the hearing. However, after the hearing, the ALJ will refer the criminal matter to OIG. If the ALJ has concerns about adjudication issues based on the testimony, the ALJ will consult with the Hearing Office Chief Administrative Law Judge and the Regional Chief Administrative Law Judge.
The ODAR employee may also choose to notify SSA management, especially when the matter involves an SSA or state agency employee, or a contractor paid by SSA.
B. Referring Suspected Violations to OIG
An ODAR employee may choose to make a referral anonymously or request that OIG keep his or her identity confidential. When making a referral, the employee should note whether he or she referred the matter to SSA management.
The preferred method of referring suspected violations to OIG is by completing and submitting the electronic version of the Form SSA-8551 (e8551) (Reporting Form for Programmatic Fraud). Step-by-step instructions for completing the form are found in Program Operations Manual System GN 04111.065.
Due to privacy concerns, ODAR employees will not report alleged SSA or state employee or contractor violations electronically by using the Form e8551. Rather, the employee will use one of the methods below.
When the employee is unable to access or otherwise complete the Form e8551, an employee may also refer suspected fraud to OIG using any of the following methods:
Calling the OIG Hotline at 1-800-269-0271 (10:00 a.m.- 4:00 p.m. EST);
Sending a fax to 410-597-0118;
Using the form provided to the public to report fraud (located at http://www.socialsecurity.gov/fraudreport/oig/public_fraud_reporting/form.htm);
Mailing a report to: OIG Hotline, P.O. Box 17768, Baltimore, Maryland 21235; or
Using the OIG Hotline website at http://eis.ba.ssa.gov/oig/Hotline.htm.
If sending a fax or mailing a report to OIG, an ODAR employee will include the same basic information that is required on an e8551. If using the paper Form SSA-8551-U4, found in POMS GN 04124.003, the employee need only complete the sections that are applicable to ODAR employees.
C. Referring Suspected Violations to SSA Management
1. Notifying Management
In addition to referring the matter to OIG, an ODAR employee may also choose to notify SSA management of a suspected violation. To do so, the ODAR employee may either verbally relay the information to a supervisor, or prepare a written memorandum that includes:
A thorough description of the circumstances for the suspected violation;
Copies of any statements or admissions from the suspected offender, statements of witnesses, copies of any contracts or agreements between the parties, and substantiating documentation and evidence including bills, receipts, canceled checks, or money orders; and
A statement about whether there are other questionable cases involving the same individual.
If an ODAR employee chooses to report a suspected violation to SSA management, the employee will typically report it to an immediate supervisor. However, if the allegation involves a person in the referring employee's management chain, the employee may choose to send the referral to the next line supervisor above the person suspected of the violation, or to another second line supervisor in the office (if applicable).
2. SSA Management Actions
An SSA manager will route a referral, including the memorandum and any supporting documentation, through his or her management chain. At the hearing level, the report will be referred through all levels of management to the Chief Administrative Law Judge (CALJ). At the Appeals Council level, the report will be referred through management to the Executive Director.
After evaluating the situation and discussing it with the ODAR Deputy Commissioner, the CALJ or Executive Director may find it appropriate to make an individual referral to the OIG Office of Investigations Field Division (see HALLEX I-1-3-90) and the ODAR Division of Quality Service.