Explaining the Fraud-Reporting Process

Beyond the Numbers

Thursday, June 28, 2012
Posted by: 
The Office of External Relations

Throughout this website, we link to our fraud reporting form.  We encourage you to use it to submit reports, aka allegations, of suspected fraud. 

But….what happens to those allegations?  We know you are curious, because we receive emails every week asking that question.  

Let’s get the legal language out of the way first.  The Privacy Act of 1974 is a wonderful thing—it protects you in many ways.  Federal Government agencies, including this one, are not allowed to share information about you or other people—even suspected criminals—from their records without the consent of that individual.  Here’s an in-depth explanation of the Privacy Act.

What does this mean?  Once you submit a report, it becomes part of our records, and we are usually prohibited by law from telling you what happens to the person you reported.   

We can, however, give you some general information about the fraud-reporting process. 

We try to act on reports of fraud within 45 days.  What kind of action might we take? 

  • Refer it to SSA for action.  They might begin a continuing disability review if they learn that someone may be receiving benefits they’re not entitled to.  Or, SSA might ask a representative payee to bring in receipts showing how they spent benefits they received.  If SSA suspects fraud after developing information, they refer it back to us for possible criminal investigation.
  • Refer it directly to one of our investigative offices across the country.  Our goal is to complete our investigations within 180 days.  Factors beyond our control—such as turning over our findings to a prosecutor—can delay the process, but more often than not, we meet this goal.
  • Refer it to another agency, if we don’t have the authority to investigate.  We get a lot of reports about Medicare fraud, for example, which we have to send to the Department of Health & Human Services OIG, or identity theft, which go to the Federal Trade Commission.
  • Impose civil monetary penalties against people who make false statements or omissions—they fail to report something—to SSA.  We can impose a penalty of up to $5,000 for each false statement or omission, plus up to twice the amount of the benefits that SSA mistakenly paid as a result.  This means that even if someone doesn’t go to prison for stealing benefits, there can still be very unpleasant consequences.

The most important thing to remember is that the more information you give us, and the more specific that information is, the more likely we will be able to investigate or refer it to SSA for action. 

If we can’t identify a person in SSA’s records based on the information you give us, we won’t be able to pursue your allegation.  We take what action we can with every allegation we receive—we just can’t tell you what that action is, or we’d be breaking the law, too.