In close coordination with Social Security’s Office of the Inspector General, we use a variety of proven techniques to identify and prevent fraud and to help investigators analyze suspicious or questionable claims. We are successful at combating fraud by using data analytics, collaborating with local law enforcement agencies to pool investigative resources, and employing technology to root out fraud. Below are examples of Social Security’s anti-fraud initiatives.

Access to Financial Institutions (AFI)

One of the leading reasons people receive undue Supplemental Security Income (SSI) payments is because they fail to properly notify us that they have more money in their financial accounts than allowed while collecting payments. The Access to Financial Institutions (AFI) program allows us to identify financial accounts, often never disclosed to us, that have large amounts of money that would preclude the individual from receiving SSI payments. Learn more about AFI at www.socialsecurity.gov/improperpayments/afi.html.

Administrative Sanctions

We are also authorized to impose Administrative Sanctions (Section 1129A of the Social Security Act), when a person knowingly provides false or misleading information to us or fails to report information material to eligibility or benefit amount. During a sanction period, benefits stop. The sanction periods are 6 months for the first occurrence, 12 months for the second occurrence, and 24 months for each additional occurrence.

Civil Monetary Penalty - Section 1129

In addition to criminal charges and restitution, federal law (Section 1129 of the Social Security Act) gives us the authority to impose a civil monetary penalty against people who defraud Social Security. When the Office of the Inspector General’s (OIG) investigators find evidence that someone provided false information or withheld information that could affect eligibility for benefits, we can impose a civil monetary penalty of up to $5,000 for each occurrence and an assessment in lieu of damages, of up to double the amount of benefits paid as a result of the fraud. We may also impose a civil monetary penalty and assessment against representative payees or joint bank account holders who misuse payments. We may impose such penalties outside a courtroom, through a settlement, or through a hearing before an administrative law judge. We collect penalties through administrative actions, including withholding future benefit payments.

Continuing Disability Review (CDR)

Social Security periodically reviews cases of people receiving disability benefits to ensure they are still eligible to receive them. We conduct a continuing disability review (CDR) approximately every three years on each person receiving disability benefits whose disability we expect to improve. We conduct a CDR approximately every five to seven years on each person receiving disability benefits whose disability we do not expect to improve. A person receiving disability benefits is required to provide medical or other evidence to us as part of the CDR. We may temporarily stop or terminate benefits if we do not have enough information to support continuing disability, and a person is intentionally withholding information from us. We may also temporarily stop or terminate benefits if we cannot locate the beneficiary.

Cooperative Disability Investigations (CDI)

The Cooperative Disability Investigations (CDI) program is one of Social Security’s most successful anti-fraud initiatives. CDI units bring together personnel from Social Security, the Office of the Inspector General, state disability determination services (DDS), and local law enforcement agencies to analyze and investigate suspicious or questionable Social Security disability claims. Currently, we have 39 Units covering 33 states, the District of Columbia, and the Commonwealth of Puerto Rico. The CDI units resolve suspected fraud before benefits are ever paid. The efforts of the CDI units help disability examiners make informed decisions, ensure payment accuracy, and generate significant taxpayer savings, for both federal and state programs.

Data Analytics

Social Security uses data analytics to predict and detect fraud.

Fraud Prevention Units

Social Security’s centralized Fraud Prevention Units identify potential fraud and fraud trends that we can apply to cases nationwide. Using specialized experience and data analytics, experts detect and prevent fraud at the earliest possible point in the decision-making process.

Fraud Prosecutors

Social Security fraud prosecutors work with offices of the U.S. Attorney around the country to bring federal criminal charges against individuals who defraud Social Security programs. These prosecutors obtain criminal sanctions, to include imprisonment, and recover funds for the agency through criminal restitution and forfeiture.

Misleading Advertising - Section 1140

Section 1140 of the Social Security Act protects Social Security’s symbols, emblems, and name. We investigate companies and people who misrepresent and use the agency’s name and image to sell their services, products, or messages. We also fight to prevent others from selling agency forms and publications without our authorization that we provide at no charge.

National Anti-Fraud Committee

Social Security’s National Anti-Fraud Committee works to make sure our agency is fighting fraud in the best and most efficient way possible. The committee considers best practices and new techniques to detect and prevent fraud. It also addresses our most critical vulnerabilities, provides a forum to collaborate and develop strategies to detect and prevent fraud, and evaluates new anti-fraud initiatives.

 

Overpayments

When we find that a person has been paid money that he or she should not have received, we work to collect any amount of benefits paid incorrectly. If the person continues to receive benefits, we withhold a portion of his or her monthly payment until the debt, or overpayment, is paid. In some cases, we can collect money from a person’s federal tax refund or accept direct payments from the person we overpaid.

Quality Assurance Reviews

Social Security regularly conducts quality assurance and performance reviews to make sure decisions and payments are correct for people applying for and receiving benefits. These quality assurance reviews happen along each step of the way, from initial decisions to the processing of appeals. It’s another way we strive to make sure we pay the right amount at the right time.

Redeterminations

For people receiving SSI payments, we regularly review a person’s income, resources, and living arrangements to make sure they still meet the eligibility requirements. We conduct a redetermination on most SSI recipients about once every one to six years.

You

You play a key role in protecting your investment in Social Security. If you suspect fraud, report it to the OIG. OIG evaluates every allegation of fraud and, for those cases where they determine fraud has occurred, aggressively pursues the case.  We encourage you to report any suspected fraud, waste, or abuse. It’s easy to report fraud online by visiting OIG’s Fraud, Waste, and Abuse page at http://oig.ssa.gov/report. You may also call the Social Security Fraud Hotline at 1-800-269-0271.