Be Careful Not to Commit Fraud or a Similar Fault When Applying for Disability

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.

What Is Disability Fraud?

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.

What's a Similar Fault to Fraud?

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:

• knowingly provides an incorrect or incomplete statement that's important and material to determining eligibility for disability, or
• knowingly conceals material information.

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.

Ways of Committing Disability Fraud

There are five categories of disability fraud:

• making false statements on claims
• not telling the whole truth about facts or events that affect your eligibility for benefits
• misuse of benefits by a representative payee
• receiving benefits after a person has died, and
• using somebody else's Social Security number.

Making False Statements by Misrepresenting a Material Fact

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.

• Giving your doctors false information. Sam filed for disability based on depression and anxiety. To help win his claim for benefits, Sam told his doctors that he had an intense fear of leaving his house, although he actually attended many parties. Based on his statements, his doctors prepared reports that supported his claim.
• Lying about how much education you have. When Dakota filed for disability, she stated that she had only completed the 6th grade when, in fact, she had gotten her GED. She did this because she knew having a marginal education would increase her chances of winning her disability claim.

Not Reporting Events That Affect Your Eligibility for Benefits

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.

• Changes in marital status. Leroy was receiving SSI benefits when he got married, and his spouse worked full-time. Because of his spouse's income, Leroy was no longer eligible for SSI. Leroy knew that reporting the additional income would cause his benefits to stop, so he didn't tell Social Security about the marriage.
• Death in the family. Lila was receiving both disability benefits and Railroad Retirement based on her spouse's work history. When her spouse died, she didn't tell Social Security because she knew that his death would end her dual payments.
• Age of a child. Deon received disability payments on behalf of his minor child, with whom he lived. When his child turned 18 and moved out of the home, Dion didn't report this because he wanted to keep receiving his child's benefits.

Lying About How Much Money You Make

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.

• Not reporting all your resources for an SSI claim. Jayden filed for SSI, the program for people with low income and low assets. At the time, Jayden owned a trailer that she rented to her uncle. The cash value of the trailer put her over the SSI resource limit, so Jayden intentionally left it out of her application so that she could qualify for benefits.
• Telling Social Security you didn't work when you did. When Sharon filed for disability, she reported that she was last able to work in February of 2021. But Sharon had worked until February 2023, shortly before filing her claim. Sharon lied about when she last worked in an attempt to get more back pay for disability benefits.

Abusing Funds as a Representative Payee

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.

• Spending payments not meant for you. Jeffery was designated as the representative payee for his adult disabled daughter. Instead of using the payments to purchase food and clothing for his daughter, Jeffery used the funds to pay down his personal debt.
• Continuing to receive payments after the death of the recipient. Marcus was the representative payee for his disabled father. When his father died, Marcus failed to notify Social Security so that he could continue to receive his father's benefits.

Using Fake 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.

• Forging documents. Zara didn't have a Social Security number because she wasn't a legal resident of the United States. Without a Social Security number, Zara couldn't apply for disability, so she used a fake birth certificate to get a Social Security number that she used on her application.
• Using somebody else's Social Security number. Louis wasn't eligible for disability benefits because he had an outstanding felony warrant for fleeing prosecution. In an attempt to get benefits, Louis filed for disability using a stolen Social Security number.

Examples of Committing a Similar Fault to Fraud

A similar fault to fraud generally falls into one of two categories:

• providing false or misleading information, and
• withholding or hiding information.

Here are some examples where a claimant or another person related to the claimant committed a similar fault to fraud.

Withholding Material Information

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.

Providing False or Misleading Information

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.

How Can You Identify Social Security Disability Fraud?

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.

What Happens if You Report Somebody for Disability Fraud?

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:

• remain confidential (the agency can contact you for more information but keeps your name secret), or
• anonymous (you don't have to share any personal information, but the agency can't contact you).

Social Security will ask you for details about the person you suspect of committing fraud, such as their:

• name
• address
• date of birth
• phone number, and
• Social Security number (if you know it).

And you should be ready to provide the following information:

• description of the type of fraud (such as abuse by a representative payee or lying about income)
• location (state or town) where the fraud took place
• when the fraud took place
• how the fraud was committed
• why the person committed the fraud (if known), and
• if anyone else knows about the fraud.

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.

What Happens to Your Claim if the SSA Decides a Similar Fault Occurred?

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:

• ignore any evidence that's based on the similar fault
• decide to do nothing because the similar fault didn't affect the outcome of the claim
• modify, deny, or discontinue benefits if eligibility for the benefits was decided using evidence based on the similar fault, or
• conduct a continuing disability review (if you're already receiving benefits) to see if you meet Social Security's definition of disabled.

If Social Security decides your claim contained evidence based on a similar fault, the agency will send you a decision letter that contains:

• an explanation of federal laws on similar fault
• a description of the evidence it disregarded
• why it believed the evidence was wrong, inaccurate, misleading, or incomplete, and
• information on how to appeal Social Security's decision.

What if Social Security Accuses You of Fraud or a Similar Fault?

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:

• fines up to $250,000
• up to 5 years in prison, or
• both.

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.