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.
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.
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.
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.
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 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.
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.
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.
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.
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:
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.
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