The Social Security Administration has issued a ruling about determining fraud and similar fault in evaluations initial applications for disability benefits.

Social Security must disregard evidence if there a reason to believe fraud or similar fault was involved in providing that evidence.  This can include disregarding evidence provided by someone who has not committed fraud or similar fault, but whose evidence relies on other evidence involving fraud or similar fault.  Fraud is defined as “when a person, with the intent to defraud, either makes or causes to be made, a false statement or misrepresentation of a material fact for use in determining rights under the Act; or conceals or fails to disclose a material fact for use in determining rights under the Act.” Similar fault is defined as “an incorrect or incomplete statement that is material to the determination is knowingly made or information that is material to the determination is knowingly concealed.”

If evidence is disregarded, Social Security evaluates the remaining evidence in the record to determine eligibility.

At a hearing, the administrative law judge considers objections to disregarding the evidence and then decides whether there is reason to believe that fraud or similar fault was involved in providing the evidence.

The Notice of Determination or Order must identify documents being disregarded and discuss the evidence that supports a finding to disregard the evidence, and then provide a determination or decision based on the remaining evidence in the record. (SSR 22-2p, May 17, 2022.)

The Social Security Administration has issued rulings about redetermining eligibility for disability benefits based on fraud or similar fault

Social Security must disregard evidence if there a reason to believe fraud or similar fault was involved in providing that evidence.  For claims that have already been granted, Social Security will redetermine eligibility and will disregard the evidence for which there is a reason to believe fraud or similar fault was involved.  Fraud is defined as “when a person, with the intent to defraud, either makes or causes to be made, a false statement or misrepresentation of a material fact for use in determining rights under the Act; or conceals or fails to disclose a material fact for use in determining rights under the Act.” Similar fault is defined as “an incorrect or incomplete statement that is material to the determination is knowingly made or information that is material to the determination is knowingly concealed.”

Social Security reevaluates the case based on the remaining evidence in the record to determine eligibility.  This includes evidence in the record at the time of the original favorable decision, and evidence provided during the redetermination process.  If the individual is found ineligible after the redetermination, benefits are terminated and the benefits paid are an overpayment.

In determining whether there a reason to believe there has been fraud or similar fault, adjudicators can make inferences based on the totality of the circumstances such as facts or case characteristics common to known or suspected patterns of fraud.  This can include disregarding evidence provided by someone who has not committed fraud or similar fault, but whose evidence relies on other evidence involving fraud or similar fault.

At a hearing, the administrative law judge considers objections to disregarding the evidence and then decides whether there is reason to believe that fraud or similar fault was involved in providing the evidence.

Initiation of a redetermination for alleged fraud or similar fault is not a determination subject to an administrative hearing or judicial review.  After redetermination, an appeal of the redetermination decision can include objections to the finding to disregard evidence.  (SSR 22-1p, May 17, 2022.)