Cooperative Disability Investigations (CDI) Program
In 1997, then-Deputy Commissioner for Programs and Policy, Carolyn W. Colvin, in collaboration with the Office of the Inspector General (OIG), created the Cooperative Disability Investigations (CDI) program to root out fraud, waste, and abuse in SSA’s disability programs. The CDI program launched with single units in five states, and it’s been growing steadily over the years.
CDI is one of Social Security’s most successful anti-fraud initiatives, contributing to the integrity of federal disability programs. CDI units bring together personnel from SSA, the OIG, State Disability Determination Services (DDS), and state and local law enforcement agencies to analyze and investigate suspicious or questionable Social Security disability claims, and to help resolve questions of fraud before benefits are paid.
The efforts of the CDI units help disability examiners make informed decisions, ensure payment accuracy, and generate significant savings for federal and state programs. In fiscal year 2015, the CDI program reported $406 million in projected savings to SSA’s disability programs and $291.5 million to non-SSA programs, such as Medicare, Medicaid, housing assistance, and food subsidy programs. Since the program launched in 1997, CDI efforts have contributed to $3.3 billion in projected savings to SSA’s programs, and $2.2 billion in projected savings to non-SSA programs.
CDI units also provide reports to DDS examiners during continuing disability reviews that can be used to stop benefits, if persons currently receiving checks are no longer eligible. “For nearly two decades, CDI has been tremendously successful in identifying and preventing disability fraud and abuse,” said SSA Inspector General Patrick P. O’Carroll, Jr.
Currently, CDI consists of 37 units covering 31 states, the District of Columbia, and the Commonwealth of Puerto Rico. The program is still growing, as SSA and the OIG plan to add another CDI unit by the end of 2016, to support the integrity of the disability programs.
The CDI program has proven to be an effective initiative to prevent disability fraud and waste. SSA and the OIG also aggressively investigate allegations of fraud and pursue prosecution of people who steal from Social Security.
Our message to those who attempt to defraud Social Security is clear: We will find you; we will prosecute you; and we will seek the maximum punishment allowed under the law. We’re committed to preserving disability benefits for those who truly deserve and depend on them.
Social Security’s San Francisco Regional Anti-Fraud Committee – Educates Employees to Combat Fraud
The San Francisco Region of the Social Security Administration (SSA) has 162 local offices, 6 telephone service centers, 17 Disability Determination Services offices, 20 hearings offices, and the Western Program Service Center. This Region serves customers in Arizona, California, Nevada, Hawaii, Guam, American Samoa and the Commonwealth of the Northern Mariana Islands. With over 6,500 employees, the Region is well prepared to provide the best service possible and is committed to protecting American taxpayers from fraud, waste, and abuse.
To combat fraud, the San Francisco Regional Anti-Fraud Committee (SF RAFC), co-chaired by the regional commissioner and Office of Inspector General (OIG) special agent-in-charge develops regional strategies to root out fraud. Educating employees and enhancing awareness about fraud is a high priority in the San Francisco Region. Some of the current initiatives to educate employees include the Think Twice First campaign, personally identifiable information (PII) reminders and “The Last Word” newsletter.
Every year since its inception in January 2007, the SF RAFC has led the Think Twice First campaign to educate employees about the agency’s Standards of Conduct. Think Twice First includes information about the Systems Sanctions Policy, the agency’s policy on proper use of government equipment, and the protection of PII. The campaign begins in January and ends in September of each year. In January 2012, the SF RAFC released the Think Twice First campaign nationwide to all components of SSA to ensure that all employees are equipped with the tools to detect fraud, waste, and abuse.
The SF RAFC also publishes “The Last Word,” a newsletter that keeps San Francisco Region employees informed on the outcomes of investigations of employee fraud, program fraud, and employee systems abuse. In addition to the publication, regional employees receive training and references that provide guidance on how to look for weaknesses or flaws in the daily operations of SSA that might make it easy for either a beneficiary or a fellow employee to commit fraud. The SF RAFC also studies and addresses such vulnerabilities. The SF RAFC uses resources available to the SSA’s Office of the Inspector General (OIG) and SSA to ensure that we take timely, efficient and effective criminal, civil or administrative actions on all reported potential fraud cases.
The OIG works closely with frontline employees and the SF RAFC to identify fraud, root out offenders, and bring them to justice. In fiscal year 2015 within the San Francisco Region, OIG closed 1,573 investigations and secured 125 criminal convictions and $52.7 million in projected savings for the American taxpayers.
The Office of Inspector General – Our Boots on the Ground in Fighting Fraud
The Social Security Administration (SSA) Office of Inspector General (OIG) is on a mission to prevent waste, fraud, and abuse in Social Security’s programs and operations. SSA’s OIG was created to conduct independent oversight of Social Security, and report its findings to the Commissioner and the U.S. Congress. It does this by investigating allegations of wrongdoing related to SSA’s programs and beneficiaries. It also audits Social Security’s programs and recommends changes to make those programs more effective and efficient.
OIG has on staff investigators, auditors, attorneys, and other specialists who possess a wealth of knowledge. They know how to get the job done! OIG’s investigative staff evaluates and pursues a variety of fraud allegations. In fiscal year 2015, OIG received over 89,000 allegations through its Fraud Hotline. Criminal investigators—also called special agents—took direct action on about 7,600 Hotline allegations, and referred nearly 25,000 more to SSA for further development. Of the nearly 25,000 referred to SSA, the agency identified over $3.4 million in overpayments.
OIG may take action on an allegation that checks were cashed after a beneficiary’s death, or a Representative payee is receiving benefits for a child who is not in his or her care, or that a disability beneficiary is concealing work. Investigative efforts can lead to criminal convictions, court-ordered restitution, administrative sanctions, or civil monetary penalties.
Special agents at OIG have close working relationships with SSA personnel and offices—they depend on each other’s expertise to effectively combat fraud. OIG is also a critical component of the Cooperative Disability Investigations (CDI) program, which helps prevent fraud before benefits are ever paid. In fiscal year 2015, CDI saved $406 million for SSA programs.
Additionally, OIG auditors work to improve the integrity of SSA’s programs, through audits and evaluations. They are committed to protecting taxpayer dollars, by finding vulnerabilities, inefficiencies, or waste, and recommending changes. They work with OIG investigators by referring suspected fraud they find during an audit or by sometimes assisting during investigations by analyzing data or records from an audit perspective.
OIG has a commitment to excellence and it shows in their teamwork and quality of life work environment. For 20 years, OIG has supported SSA’s goals of inspiring public confidence by detecting and preventing fraud, waste, and abuse. OIG’s work saves billions of dollars for SSA programs and American taxpayers.
If you suspect someone of committing fraud, there are several ways to report it. You can submit a report online at http://oig.ssa.gov/report, or go to https://www.ssa.gov/antifraudfacts and click report fraud; write to the Social Security Fraud Hotline, P. O. Box 17785, Baltimore, MD 21235; fax 410-597-0118, or phone 1-800-269-0271 from 10 a.m. to 4 p.m. Eastern Standard Time, Monday through Friday. If you are deaf or have impaired hearing, call 1-866-501-2101.
Representative Payee Misuse
We provide monthly payments to retirees, disabled persons, and families of retired, disabled, or deceased workers. At times, some people are not able to manage or direct someone else to manage their finances due to their age or physical or mental impairment. In these cases, we will appoint a representative payee (payee).
A payee can be a relative, friend, organization, institution, legal guardian, or other interested person. As a payee, you are responsible for receiving, managing, and using the payments for the beneficiary’s care (e.g., food, shelter, clothing, and personal care items). The payee must save any money left over after meeting the beneficiary’s day-to-day and personal needs.
Once a payee is appointed, the agency monitors the payee to help ensure continued qualification to serve and to evaluate whether the payee is properly using the benefits. Each year, payees are required to submit a report accounting for the use of beneficiary funds. Monitoring payee activities helps deter and detect misuse.
If we are suspicious or receive an allegation that the appointed payee may not have properly used the funds for the beneficiary’s care, we may investigate or refer the suspicion or allegation to the Office of Inspector General (OIG). If the investigation determines a payee misused funds, OIG may refer the case to the Department of Justice (DOJ) for criminal prosecution. The penalty upon conviction for a payee’s misuse of funds may be a fine up to $250,000, up to ten years imprisonment, or both.
If the DOJ does not criminally prosecute, OIG may impose a civil monetary penalty up to $5,000 for each payment or partial payment misused and an assessment of not more than twice the amount of the misused payments.
For example, in August 2015, a Massachusetts woman was sentenced to 24 months’ probation, including six months’ home confinement, and was ordered to repay $32,000 to us for misuse of funds as a payee.
In 2012, the woman became the payee for one of our beneficiaries who was a disabled hospital resident. A local police department notified the OIG of the suspicion that she was misusing the beneficiary’s benefits. The investigation revealed that the woman received payments for the beneficiary for two years, totaling over $45,000; however, she spent only about $13,000 on his care. She spent the remaining $32,000 on herself, for things like vacations, restaurant and retail purchases, leaving the beneficiary in debt with thousands of dollars owed to the facility providing his care. She pleaded guilty to representative payee fraud.
Misusing the benefits intended to assist those truly in need is an intolerable crime. We have no higher priority than the protection of beneficiaries who cannot defend themselves, and will continue to seek prosecution of and restitution from those individuals who steal from our beneficiaries and violate their trust!
The Fugitive Felon Program
If you’re a fleeing felon, you aren’t eligible for Social Security benefits, and we’ll overturn every stone to find you.
Take, for example, the story of one fugitive felon who eluded law enforcement by living under an alias in the Pacific Northwest for more than 20 years. His misstep occurred last year, when he applied for Social Security benefits in Oregon using his true identity. Social Security’s Office of Inspector General and local law enforcement used this information to track him down, and in October 2014, they arrested him along the coast of Oregon. Our message is clear: No matter how long it takes, we’ll find you, and you’ll be held responsible for your crime.
The Social Security Act prohibits us from paying Supplemental Security Income and Social Security Disability or Retirement benefits if
- you have an unsatisfied warrant for fleeing arrest or
- you are fleeing custody or confinement after a conviction for committing or attempting to commit a felony.
Benefits aren’t payable to fleeing felons beginning with the month of the outstanding warrant, but are payable again the month after the warrant is satisfied. In most cases, this will be the month after the month the fugitive surrenders to, or is arrested by, law enforcement officials. Warrants are satisfied in one of three ways: the person either surrenders to law enforcement or is arrested, or a judge dismisses charges or otherwise discontinues the warrant.
The Social Security Act also requires us to exchange information with local law enforcement officials about fugitive felons and probation or parole violators, to aid in locating and apprehending them. This provision also prohibits some convicted felons from serving as representative payees.
In fiscal year 2014, law enforcement agencies around the country located and arrested 371 fugitives as a result of this information sharing. We also suspended benefits for 830 people and identified almost $3 million in benefit overpayments. The Fugitive Felon Program is one more way we serve the American taxpayer – by helping bring fugitives to justice and making our local communities safer.
Are you a fleeing felon? We’re closer than you think.
Continuing Disability Review: A Program Integrity Tool for Disability Adjudicators
Disability adjudicators are the frontline workers in Disability Determination Services (DDS) across the country. They play a critical role in administering Social Security's disability programs and serving our citizens. Each of the 50 states, Washington, D.C., Guam, the Virgin Islands, Puerto Rico, and Federal Disability Branches throughout the country have DDSs that handle the agency’s disability workload. Last year, approximately nine million beneficiaries received Social Security Disability Insurance (SSDI) benefits.
To confirm eligibility for benefits and to guard against fraud and waste, DDS conducts periodic continuing disability reviews (CDR) for each person receiving disability benefits. Disability adjudicators review and compare new medical evidence from the time of the most recent approval, analyze employment information, interview the beneficiary, and clarify any unresolved or questionable issues. At times, adjudicators consult with physicians or other experts, such as vocational consultants during a CDR.
Disability adjudicators have extensive knowledge of medical conditions (both physical and mental), and are trained to identify potential fraud indicators. When disability adjudicators identify potential fraud during a CDR, the allegations are reported to the Office of Inspector General (OIG). Some states have a Cooperative Disability Investigations (CDI) unit. If a state has a CDI unit, the allegations are reported to them. The submission of the online electronic referral form, the SSA e8551, “Reporting Form for Programmatic Fraud” is used to document the allegations. The OIG and CDI units work closely with employees from DDS and Social Security to identify fraudulent offenders and bring them to justice.
In fiscal year 2014, DDS referred about 5,400 fraud allegations to the OIG, resulting in millions of dollars in savings to Social Security’s disability programs. People who commit fraud can face penalties such as repayment of stolen funds, fines, and/or imprisonment. Additionally, people who commit such acts are subject to administrative penalties or civil monetary penalties.
Fighting fraud is an ongoing process and no amount of fraud is acceptable. Social Security tirelessly seeks to identify and punish those who attempt to defraud American taxpayers, and disability adjudicators are certainly doing their part!
Identity theft is a significant threat to all consumers. Last year, the Federal Trade Commission (FTC) received more than 330,000 complaints from consumers who were victims of identity theft.
Identity theft occurs when someone steals your personal information and uses it with the intention of committing fraud. Personal information could be your name, date of birth, Social Security number (SSN), or your driver’s license and credit cards.
To a thief, your SSN is usually the key to unlocking your identity. Identity thieves can use your number and your good credit to apply for loans, credit cards, and other benefits in your name. Identity thieves then use the credit cards without paying the bills, thereby damaging your finances, credit history, and reputation.
To protect against identity theft:
- Avoid carrying your Social Security card or other documents that display your SSN. Leave them in a secure place.
- If someone requests your SSN, ask questions. You have a right to know why your number is needed, how it will be used, and what law requires you to share your number.
- Keep your information secure by shredding documents that include personal information, storing financial documents and records in a safe place, and installing anti-virus protection software on personal computers.
In fiscal year 2014, the Office of Inspector General received more than 121,000 allegations of fraud. Of this total, about 12.5 percent were allegations related to SSN misuse.
Under the Identity Theft Penalty Enhancement Act of 2005, SSN misuse is a felony, and penalties include fines and prison time—or both!
Congress also passed the Identity Theft and Assumption Deterrence Act of 1998 that officially listed identity theft as a federal crime. Identity theft carries a maximum penalty of 15 years imprisonment and substantial fines.
If you suspect someone is using your SSN for work purposes, you should contact us to report the problem. Call us toll free at 1-800-772-1213 or at our TTY number, 1-800-325-0778, if you are deaf or hard of hearing. We will review your earnings with you to ensure our records are correct. You also may review earnings posted to your record on your Social Security Statement. To get your Statement, go to www.socialsecurity.gov/myaccount and sign up for a my Social Security account.
If someone has misused your SSN or other personal information to create credit or other problems for you, Social Security can’t resolve these issues. If you suspect someone has stolen your information, visit www.identitytheft.gov. The new F TC website is a one-stop national resource to learn additional information about identity theft.
If you are a current or former Federal employee and believe your personal data may have been compromised in the U.S. Office of Personnel Management’s cybersecurity incident, you can find additional information athttp://www.csid.com/opm. For more information to specific questions, visit OPM’s Frequently Asked Questions page. Note, only current and former Federal employees are thought to be impacted by the incident.
Identity theft is serious! Don’t be a victim—take steps today to protect yourself!
A whistleblower discloses any kind of information or activity that is illegal, dishonest, or incorrect within an organization. A whistleblower is typically a current, potential, or former employee who suspects someone is in violation of a law, rule, or regulation. A violation could be abuse of authority, gross waste of funds, specific danger to public health or safety, and gross mismanagement.
Some people may not report suspected wrongdoing because they are afraid of negative consequences. Don’t be afraid, because Federal Whistleblower Protection laws prohibit retaliation for speaking out against illegal, wasteful, and dangerous practices. This means the federal government cannot fire, demote, suspend, threaten, harass, or discriminate against a whistleblower. The Office of the Inspector General and U.S. Office of Special Counsel are available to receive and investigate whistleblower allegations.
A federal agency violates the Whistleblower Protection Act if it takes or threatens to take retaliatory personnel action against any employee because of disclosure of information.
Social Security’s biggest detector of fraud is you. We need you to help us detect and deter fraud, waste, and abuse. Reporting wrongful acts can save lives and taxpayers dollars. For additional information on whistleblower protection, go to http://oig.ssa.gov/whistleblower-protection. You can find the various ways to submit a report here.
Don’t be afraid. Speak up!
Cooperative Disability Investigator- Zero Tolerance for Fraud
One of our most effective measures to guard against fraud is the Cooperative Disability Investigations (CDI) program. CDI supports the agency’s strategic goal of ensuring the integrity of Social Security programs, with zero tolerance for fraud. Under the program, we investigate suspicious disability claims early, before making a decision to award benefits—in effect, proactively stopping fraud before it happens.
Each CDI unit has an Office of the Inspector General (OIG) special agent who serves as the team leader; a Social Security Administration (SSA) employee and employees from that State’s disability determination services (DDS) who act as programmatic experts; and State or local law enforcement officers.
Disability fraud can involve concealing work or other activities, exaggerating or lying about disabilities, or filing multiple applications. The investigative process begins with a fraud referral to the CDI units from the DDS or SSA. The units also receive referrals from SSA’s Office of Disability Adjudication and Review, private citizens, anonymous sources, and other law enforcement agencies.
The CDI unit examines claims identified as suspicious and gathers evidence by conducting interviews, capturing surveillance videos, and researching records. Upon completion, the CDI provides a Summary Report of Investigation to the DDS for use in making timely and accurate disability determinations. When appropriate, CDI investigators assist in seeking criminal prosecution of applicants and beneficiaries and refer cases for consideration of civil monetary penalties or administrative sanctions. Additionally, the CDI investigates doctors, lawyers, interpreters, and other third parties who facilitate and promote disability fraud.
Since established in 1998, CDI has contributed $3.1 billion in projected savings to SSA’s disability programs and $2 billion in projected savings to non-SSA programs.
We take fraud seriously and will seek prosecution of those involved to the fullest extent of the law!
Office of Anti-Fraud Programs
Our Office of Anti-Fraud Programs (OAFP) is the newest member of Social Security’s team supporting our continued mission to combat fraud. Acting Commissioner Carolyn W. Colvin saw the opportunity to centralize Social Security’s efforts to identify fraud that undermines our mission to serve the American public, and she took it!
The mission of OAFP, established in November 2014, is to efficiently and effectively detect, deter, and mitigate fraud, waste, and abuse of our programs. OAFP works closely with our Office of the Inspector General to ensure that there are consequences for those who commit fraud — even if the act isn’t prosecuted.
Acting Associate Commissioner Michelle King and Deputy Associate Commissioner Jon Tortora lead the OAFP staff. The office consists of two units. The Division of Anti-Fraud Policy and Planning is responsible for implementing the anti-fraud framework for Social Security and supporting the operating model and workforce development initiatives. The Division of Analytics and Operations is responsible for operating enterprise anti-fraud analytics and risk- scoring solutions.
Social Security has zero tolerance for fraud. As Commissioner Colvin has said to people who would commit fraud, “We will find you; we will prosecute you; we will seek the maximum punishment allowable under the law; and we will fight to restore the money you’ve stolen to the American people.” OAFP wants to thank everyone for their diligence and commitment to taking steps to prevent and resolve fraud.