I-1-3-6.Reporting Fraud or Criminal Violations by Representatives

Last Update: 12/13/13 (Transmittal I-1-69)

A. General

As used in this section, the term “representative” refers to an individual who has been appointed as a representative in matters before the Social Security Administration (SSA). These procedures may apply even if the individual is not currently appointed as a representative in any matter pending before SSA.

An attorney or non-attorney representative of persons claiming benefits under the Social Security Act may be criminally charged if he or she commits any of the following offenses:

  • In any manner willfully and knowingly deceives, misleads, or threatens any claimant, prospective claimant, or beneficiary;

  • Charges or collects or makes any agreement to charge or collect, directly or indirectly, any fee in excess of the maximum fee authorized by the Commissioner of Social Security or the amount authorized by a court of law; and

  • Divulges, except when legally authorized, any information SSA furnishes or discloses about the claim or prospective claim of another person.

NOTE:

Not all representative misconduct is criminal or fraudulent. Refer to 20 CFR 404.1740 and 416.1540 for affirmative duties for representatives and prohibited actions. If a misconduct referral is appropriate, refer to the procedures in Hearings, Appeals and Litigation Law (HALLEX) manual I-1-1-50 for suspected non-fee-related violations and HALLEX I-1-2-81 for suspected fee violations.

Although the standard for an individual to be convicted of a criminal charge is proof beyond a reasonable doubt, SSA employees must refer any suspected criminal or fraudulent actions.

B. Referring Suspected Criminal Violations

When an Office of Disability Adjudication and Review (ODAR) employee observes a suspected criminal violation by an appointed representative, the employee must refer the matter to both the Office of the Inspector General (OIG) and the Office of the General Counsel (OGC).

1. Referral to OIG

An ODAR employee may choose to do so anonymously or request that OIG keep his or her identity confidential. In the referral, the employee should specifically state that OGC has been or will be notified of the referral.

The preferred method of referring suspected violations to OIG is by completing and submitting the electronic version of the Form SSA-8551 (e8551) (Reporting Form for Programmatic Fraud). Step-by-step instructions for completing this form are found in Program Operations Manual System (POMS) GN 04111.065.

When the employee is unable to access or otherwise complete the Form e8551, the employee may also refer suspected representative fraud to OIG using any of the following methods:

  • Calling the OIG Hotline at 1-800-269-0271 (10:00 a.m.- 4:00 p.m. EST);

  • Sending a fax to 410-597-0118;

  • Using the form provided for the public to report fraud (located at http://www.socialsecurity.gov/fraudreport/oig/public_fraud_reporting/form.htm);

  • Mailing a report to: OIG Hotline, P.O. Box 17768, Baltimore, Maryland 21235; or

  • Using the OIG Hotline website at http://eis.ba.ssa.gov/oig/Hotline.htm.

NOTE:

If sending a fax or mailing a report to OIG, an ODAR employee will include the same basic information that is required on an e8551. If using the paper Form SSA-8551-U4, found in POMS GN 04124.003, the employee need only complete the sections that are applicable to ODAR employees.

2. Referral to OGC

For non-fee-related violations, an ODAR employee will use the procedures in HALLEX I-1-1-50 to refer the alleged violation. For suspected fee related violations, an ODAR employee will use the referral procedures in HALLEX I-1-2-81.

The referring office will also consider the following:

  • If the circumstances of the suspected violation are not case specific, the referring office will provide a thorough description of the circumstances for the suspected violation and adhere as closely as possible to the procedures outlined in the applicable HALLEX section.

  • In all cases, the referral should include copies of any statements or admissions from the suspected offender, statements of witnesses, copies of any contracts or agreements between the parties, and any substantiating documentation and evidence including bills, receipts, canceled checks, or money orders.

  • The referring office will also indicate whether there are other questionable cases involving the same individual.

  • The referral will state that OIG has been contacted.