Getting in Trouble With Social Security for a "Similar Fault" to Disability Fraud

A disability applicant who gives inaccurate information can be convicted of a similar fault to fraud even if he or she didn't intend to defraud Social Security.

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Social Security Administration (SSA) can prosecute a person for giving false or inaccurate information for the purposes of getting Social Security benefits under two names: “fraud” and a “similar fault” to fraud. Fraud is when a claimant gives false information related to a disability claim or Social Security records. To be convicted of fraud, the SSA must prove that the person intended to defraud the government. Similar fault, however, differs from fraud because the person does not need to have intended to defraud the SSA. (For more information on what constitutes fraud, see our article on disability fraud.)

How does the SSA Define “Similar Fault”

The SSA defines similar fault (SF) in the following way:

  • when a claimant (applicant) provides an incorrect or incomplete statement that will be important in determining the claimant's eligibility for disability, and the claimant does this knowingly, OR
  • when a claimant conceals information important to the determination of eligibility, and the claimant does this knowingly.

In addition, any other person (like a doctor or interpreter) involved in the claim can commit similar fault.

What Is Important Material Information?

The SSA calls information that is important to determining eligibility "material" -- information that could help the SSA decide a claimant’s eligibility for either SSI or SSDI.

What Does Knowingly Mean?

To knowingly provide false or inaccurate information means to do so with the awareness that the information is false, inaccurate, or incomplete.

Examples of Similar Fault

Here are some examples where a claimant or another person related to the claim committed SF.

  • The claimant filed for disability based on severe carpal tunnel syndrome in both hands. She originally visited a hand specialist who advised her that she was not a candidate for surgery, and that likely the nerve damage could not be corrected. The claimant provided these medical records and the doctor’s opinion to the SSA in support of her claim. However, shortly after applying for disability, the claimant went to a new doctor for a second opinion. The second doctor conducted additional nerve testing and concluded that, in fact, she was an excellent candidate for surgery and could likely make a near compete recovery. Because this opinion and the new medical evidence did not support her case, the claimant failed to disclose it to the SSA.
  • The claimant filed for disability due to a back problem. Because the claimant did not speak English, he brought an interpreter with him to assist with his application. When the field officer asked the claimant to describe his pain, the claimant stated (in his own language) that it was a shooting and burning sensation that went from his right hip down his leg. However, the interpreter intentionally magnified the claimant’s symptoms when she translated the claimant’s response to the field officer’s question. Specifically, the interpreter stated that the claimant had significant pain in both legs and had difficulty required help in his daily life with cooking, cleaning, and personal care.

How Does the SSA Prove Similar Fault?

To prove similar fault, the SSA has to meet only a standard called “preponderance of evidence.” This means that the SSA doesn’t need any specific evidence, or a certain amount of evidence to prove beyond a reasonable doubt that someone knowingly mislead the SSA on a material fact. The SSA only needs to show that there is sufficient evidence that, “when fairly considered,” convinces the SSA that SF exists. You can learn more about how the SSA defines SF in this policy interpretation ruling on fault.

What Happens if the SSA Decides Similar Fault Occurred?

If the SSA determines that a similar fault to fraud occurred in a disability claim, there are several things that can happen.

  • The SSA can decide to do nothing because the SF did not affect the outcome of the claim.
  • The SSA can disregard any evidence it determines was based on the SF.
  • The SSA can modify, deny, or discontinue benefits if eligibility for the benefits was decided using evidence based on SF.
  • The claimant may be required to repay any benefits he or she was not legally entitled to.
  • If the claimant is receiving benefits, the SSA may conduct a continuing disability review (CDR) to see if the claimant is disabled, or
  • The case can be referred to the Office of the Attorney General or United State’s Attorney’s Office for civil or criminal prosecution.

If the SSA decides your claim contained evidence based on SF, your decision letter will contain an explanation of federal laws on similar fault, a description of the evidence it disregarded, why it believed the evidence was based on SF, and information on how to appeal the SSA's decision.

What Are the Criminal Penalties for SF?

The criminal penalties for SF, if convicted, include the possibility of jail time and monetary fines. If you are convicted of SF, you face a fine of up to $10,000 and jail for up to 15 years. You can be prosecuted even if you never received disability payments from the SSA.

If the SSA accuses you of committing fraud or a similar fault, contact a disability lawyer immediately.

by: , Contributing Author

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