Be Careful Not to Commit Fraud When Applying for Disability

The Social Security Administration (SSA) 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.

If Social Security discovers that you knowingly lied or misrepresented any information related to your disability claim or eligibility for benefits, you may 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 somebody receives a benefit from the Social Security Administration that they're not entitled to. The fraud can include receiving monthly Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) checks when a person isn't disabled or doesn't meet the income or resource requirements for the program.

Ways of Committing Disability Fraud

Categories of disability fraud include making false statements on claims, not telling the whole truth about facts or events that determine whether you're eligible 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 the agency 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 saying to 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. A claimant filed for disability based on depression and anxiety. To help win his claim for benefits, the claimant 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 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 education would increase his chances of winning his 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 your marital status. A claimant who had been receiving SSI benefits later got married, and his spouse worked full-time. Because of his spouse's income, the claimant was no longer eligible for SSI. The claimant knew that the additional income would stop his benefits, so he didn't tell Social Security about the marriage.
• Death in the family. The claimant was receiving both disability benefits and Railroad Retirement based on her spouse's work history. When her spouse died, she didn't tell SSA, because she knew that his death would end her dual payments.
• Age of a child. A claimant received disability payments on behalf of his minor child, with whom he lived. When his child turned 18 and moved out of the home, the claimant didn't report this because he wanted to keep receiving his child's benefits.

Lying About How Much Money You Make

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.

• Not reporting all your resources for an SSI claim. A claimant filed for SSI, the program for people with low income and low assets. The claimant owned a trailer that she rented to her uncle. The cash value of the trailer put her over the SSI resource limit, so she intentionally left it out of her application so that she could qualify for benefits.
• Telling the SSA you didn't work when you did. When the claimant filed for disability, she reported that she was last able to work in February of 2014. However, the claimant had in fact worked until February 2016, shortly before filing her claim. The claimant 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 who has been selected by the SSA 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. A father was designated as the representative payee for his adult disabled daughter. Instead of using the payments to purchase food and clothing for his daughter, the father used the funds to pay down his personal debt.
• Continuing to receive payments after the death of the recipient. A son was the representative payee for his disabled father. When his father died, the son failed to notify the SSA 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. A claimant didn't have a Social Security number because she wasn't a legal resident. Without a Social Security number, she 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. The claimant wasn't eligible for disability benefits because she had an outstanding felony warrant for fleeing prosecution. In an attempt to get benefits, she filed for disability using a stolen Social Security number.

How Can You Identify Social Security Disability Fraud?

Disability fraud happens a lot less frequently than many people believe, but it's not always easy to spot when it does occur. Most disability attorneys have heard stories from clients who are certain their neighbor is receiving benefits fraudulently because they've seen them driving back from the store and carrying bags of groceries. But these observations aren't even enough to show that they're not disabled, much less that they defrauded the SSA.

Remember that the person must intend to lie or provide false information to Social Security 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 that somebody is purposefully misrepresenting themselves to the agency, you'll need to use your best judgment. If you're close enough to somebody to know that they're still receiving benefits meant for their spouse who died last year, you might want to report fraud, but not every case is as clear cut.

Regardless, reporting somebody for disability fraud isn't an action you should take lightly. False reporting of fraud carries significant penalties.

What Happens When 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. The SSA will ask if you'd like to 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).

The SSA 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). 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) of 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 Social Security Administration 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 may 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. You won't receive any updates on the status of your fraud report, however.

What Are the Penalties for Disability Fraud?

If you‘re convicted of Social Security fraud, you can be fined up to $250,000, incarcerated for up to 5 years, or both, depending on the law you violated. People in positions of trust, such as medical professionals and representative payees, can face an additional 10 years of prison. 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 agency. If you are accused of fraud, or lying on your application, contact a disability lawyer right away.

_{Updated October 27, 2022}