The Social Security Administration (SSA) sometimes find that a disability applicant or recipient gave false or inaccurate information for the purpose of getting Social Security benefits. The SSA uses two names to describe this type of wrongdoing: "fraud" and a "similar fault" to fraud. The chief difference between the two comes down to intent.
Social Security takes evidence of disability fraud very seriously. The agency has its own anti-fraud initiative, the Cooperative Disability Investigations (CDI) unit, that reviews questionable disability applications and possible instances of fraud and similar faults.
If Social Security discovers that you knowingly lied or misrepresented any information related to your disability claim or eligibility for benefits, you could face criminal charges. Be aware of potential pitfalls that might lead the SSA to believe that your claim is fraudulent.
Disability fraud occurs when a disability applicant or recipient gives false information related to a disability claim. To be convicted of fraud, Social Security must prove that you intended to defraud the government.
The fraud can include receiving (or trying to get) monthly Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) checks when you aren't disabled or don't meet the income or resource requirements for the program.
Similar fault (SF) differs from fraud because the person doesn't need to have intended to defraud Social Security. The SSA defines similar fault as when an applicant either:
Information is considered "material" if it's important to determining whether someone is eligible for benefits. And "knowingly" means the person providing the information is aware that it's false, inaccurate, or incomplete.
A disability applicant, recipient, or any other person (like a doctor or interpreter) involved in the claim can commit a similar fault to fraud. But Social Security must have reason to believe the person providing the evidence knew it was false or incomplete to consider it a similar fault.
Social Security describes similar fault in more detail in its policy ruling SSR 22-2p.
There are five categories of disability fraud:
A fact is material when the SSA relies on it to help determine the outcome of your claim. Telling Social Security that you graduated from Harvard when you actually went to Yale isn't a material fact because it doesn't change whether the SSA finds you disabled. But if you're regularly using street drugs and tell Social Security that you're clean and sober, that's a material fact that can change the outcome of your claim.
You commit fraud if you lie, misrepresent, or cause anyone else to misrepresent or lie about a material fact so that you can get disability benefits. Here are some examples using fictional disability applicants ("claimants") committing fraud.
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.
Social Security uses your earnings to determine your eligibility for SSI or 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.
A representative payee is a person Social Security selects to receive disability payments on someone else's behalf. The representative payee is required to spend the payments for the benefit of the recipient. Representative payees commit fraud if they use the funds for any other reason than for the benefit of the recipient. Here are some examples.
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.
A similar fault to fraud generally falls into one of two categories:
Here are some examples where a claimant or another person related to the claimant committed a similar fault to fraud.
Connie filed for disability based on severe carpal tunnel syndrome in both hands. She had visited a hand specialist who advised her that she wasn't a candidate for surgery and that the nerve damage likely couldn't be corrected. Connie provided these medical records and the doctor's opinion to Social Security in support of her claim.
But shortly after applying for disability, Connie got a second opinion from a new doctor. The second doctor conducted additional nerve testing and concluded that Connie was an excellent candidate for surgery and would likely make a near-complete recovery.
Because this second opinion and the new medical evidence didn't support her case, Connie failed to disclose it to Social Security.
Ajay filed for disability due to a back problem. Because he didn't speak English, Ajay brought an interpreter with him to assist with his application.
When the Social Security field officer asked Ajay to describe his pain, he said (in his own language) that it was a shooting and burning sensation that went from his right hip down his leg.
The interpreter intentionally magnified Ajay's symptoms when she translated his response to the field officer's question. Specifically, she stated that Ajay had significant pain in both legs and required help in his daily life with tasks like cooking, cleaning, and personal care.
Disability fraud happens a lot less frequently than many people believe. And it's not always easy to spot when it does occur.
You might think a neighbor woman getting SSI is receiving benefits fraudulently because you've seen her driving back from the store and carrying bags of groceries. But these observations aren't even enough to show that somebody isn't disabled—much less that someone defrauded Social Security.
Remember that the person must intend to lie or provide false information to Social Security to get benefits before they can be charged with fraud. It's unlikely that somebody will tell you straight out, "I'm going to lie about my back pain to get disability," so if you think someone is purposefully misrepresenting themselves to the agency, you'll need to use your best judgment.
For instance, if you're close enough to someone to know that the person is still receiving a deceased spouse's benefits, you might want to report fraud. But not every case is so clear-cut.
And reporting someone for disability fraud isn't an action you should take lightly. False reporting of fraud carries significant penalties.
You can report disability fraud to Social Security using an online form or by calling the fraud hotline at 800-269-0271. You can choose to either:
Social Security will ask you for details about the person you suspect of committing fraud, such as their:
And you should be ready to provide the following information:
The SSA's Office of the Inspector General will review your report and take appropriate action. If the office thinks the report has substance, it might refer your claim to the Cooperative Disability Investigations (CDI) unit.
The CDI unit might send an investigator to observe the person suspected of disability fraud and write a report. The CDI report will mention any inconsistencies in the person's activities of daily living and can include interviews with neighbors. But you won't receive any updates on the status of your fraud report.
If Social Security determines that you (or someone else involved in your disability claim) committed a fault similar to fraud, the SSA can take any of the following actions:
If Social Security decides your claim contained evidence based on a similar fault, the agency will send you a decision letter that contains:
Social Security might not pursue criminal charges if the agency believes you committed a similar fault to fraud. But you could lose your disability benefits and will likely have to repay any benefits you weren't legally entitled to. (Social Security treats those benefits as overpayments.)
If Social Security's CID unit thinks you tried to defraud the SSA, you can be prosecuted—even if your claim was denied and you never received any disability benefits. (42 U.S.C. § 408.) If you‘re convicted of Social Security fraud, depending on the law you violated, you could be sentenced to:
People in positions of trust, such as medical professionals and representative payees, can face an additional 10 years of prison time for Social Security fraud.
If Social Security accuses you of committing fraud or a similar fault, contact a disability lawyer immediately.
Updated December 29, 2023