Be Careful Not to Commit Fraud When Applying for Disability

Don't misrepresent or omit facts when dealing with Social Security, or you can be prosecuted for fraud.

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If the Social Security Administration (SSA) discovers that you knowingly lied or misrepresented any information related to your claim or eligibility for disability benefits, you may face criminal charges for fraud.

Material Facts

A material fact is one that the SSA relies to help determine the outcome of your claim. You commit fraud if you do any of the following so that you can get SSI or SSDI: lie about a material fact, misrepresent a material fact, or cause anyone else to lie about or misrepresent a material fact. Here are some examples.

  • A claimant (applicant) filed for SSI, the program for those with low income and low assets. The claimant owned a trailer that she rented to a relative. This asset made the claimant ineligible for SSI. However, when she filed for disability, the claimant intentionally withheld this information so that she could qualify for benefits.
  • A claimant filed for disability based on depression and anxiety. To help win his claim for disability, the claimant made false statements to his therapist and physician about how his symptoms affected his daily life. Based on these statements, his medical providers prepared reports that supported his claim.
  • When the claimant filed for disability, he stated that he had only completed the 6th grade when, in fact, he had obtained his GED. He did this because he knew having a marginal educaiton would increase his chances of winning his claim.

Wages

The SSA uses your earnings to determine whether you are eligible for SSI or for SSDI. If you lie about your income, or cause anyone else to lie about your income to get benefits, you commit fraud. Here are some examples.

  • The claimant was self-employed as a landscaper and filed for disability because of a back injury. Because he had not paid Social Security tax on his earnings, he was not eligible for SSDI. He also didn't qualify for SSI because the net earnings from his self-employment were over the limit for SSI. But the claimant did not report his earnings to the SSA to try to qualify.
  • When the claimant filed for disability, she reported that she was last able to work in February of 2010. However, the claimant had in fact worked until February 2012, shortly before filing her claim. The claimant lied about when she last worked in an attempt get more back pay for disability benefits.

Right to Payment

You commit fraud if you hide or fail to report anything that could affect your right to your own disability benefits or to benefits you receive on behalf of someone else. Here are some examples.

  • The claimant, a single woman, had been receiving SSI benefits. Sometime after her benefits began, she married, and her spouse worked full-time. Because of his income, the claimant was no longer eligible for SSI. The claimant knew that her change in circumstances would stop her benefits, so she did not report the marriage to the SSA.
  • The claimant was receiving both Social Security and Railroad Retirement based on her spouse’s work history. When her husband died, she did not report it to the SSA, because she knew that his death would end her dual payments.
  • The individual received disability payments on behalf of his minor child, with whom he lived. The child subsequently moved out of the home; however, the individual did not report this, so that he could continue to receive the child’s benefits.
  • An adult child was the representative payee for her disabled father. When her father died, the daughter failed to notify the SSA so that she could continue to receive his benefits.

Representative Payee

A representative payee is a person who has been designated by the SSA to receive disability payments on someone else’s behalf. The representative payee has the duty to spend the payments for the benefit of the recipient. A representative payee commits fraud if he or she uses the funds for any other reason than for the benefit of the recipient. Here are some examples.

  • A father was designated as his adult disabled daughter’s representative payee. Instead of using the payments to purchase food and clothing for his daughter, the father used the funds to make payments on his personal debt.
  • An adult child was the representative payee for her disabled mother. Instead of using the funds for the care of her mother, the daughter used the money to purchase clothing, school-related supplies, and extra-curricular activities for her children.

Social Security Numbers

You commit fraud if you knowingly use fake information to get a Social Security number to establish a Social Security record. You also commit fraud if you use a fake Social Security number or one that isn’t yours to qualify for disability benefits or to increase the amount of benefits. Here are some examples.

  • An individual did not have a Social Security number because he lived in the U.S. illegally. Without a Social Security number, the individual could not apply for disability. To qualify for benefits, the individual used a fake birth certificate to get a Social Security number, which he then used on his application for disability.
  • An individual was ineligible for disability benefits because she had an outstanding felony warrant for fleeing prosecution. In an attempt to get disability benefits, the individual filed for disability using a stolen Social Security number.

For more information on benefits for non-citizens, see our section on non-medical eligibility for disability. You can also learn more about how felony convictions and incarceration affect the right to disability.

Penalty for Social Security Fraud

If you are convicted of Social Security fraud, you can be fined up to $10,000, incarcerated for up to 15 years, or both, depending on the law you violated. Keep in mind that you can be prosecuted even if the SSA never made payments to you (in other words, you were denied disability benefits).

To be convicted of fraud, the SSA must prove that you intended to defraud the SSA. If you are accused of fraud, or lying on your application, contact a disability lawyer right away. 

by: , Contributing Author

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