Does the SSA Investigate Disability Fraud?

The Social Security Disability Insurance (SSDI) program provides benefits to individuals who are no longer able to work due to a disability. To be eligible for the program, you must meet certain requirements, such as paying adequate Social Security taxes and being diagnosed with a qualifying disability. If you meet these requirements, your application should be approved. 

Unfortunately, there are some individuals who fraudulently apply for SSDI benefits. Many people wonder if the Social Security Administration (SSA) investigates fraudulent claims, and the answer is a resounding “yes.” Sometimes the SSA mistakenly investigates legitimate claims, which can be extremely stressful for an applicant who has done nothing wrong. 

The SSDI claims process is often complicated and confusing. If you are having trouble with your application or appeal, contact The Law Offices of Michael Hartup for expert legal advice and representation in Tennessee. To schedule a consultation, call 731-424-5559 or contact us online.

The Office of the Inspector General’s Cooperative Disability Investigations Program

The SSA Office of the Inspector General (OIG)  is responsible for investigating possible fraud in the various SSA programs, including disability benefits. The OIG may investigate situations involving falsified medical records, misuse of SSDI benefits, impersonation of SSA personnel, and other illegal behavior.

The Cooperative Disability Investigations (CDI) program handles most fraud investigations. This program started in 1997 with a few CDI units, and the Bipartisan Budget Act of 2015 mandated nationwide coverage by CDI by the 2022 fiscal year. There are currently 49 DCI units, each of which usually includes an OID special agent along with other SSA personnel, state Disability Determination Services (DDS) personnel, and state or local law enforcement professionals.

What Constitutes SSDI Fraud?

There are countless ways an individual (or group of people) could try to fraudulently obtain disability benefits, but here are a few examples:

  • Failing to report gainful employment and earned income while receiving disability benefits
  • Continuing to receive and cash disability payments of a deceased SSA beneficiary
  • Falsifying medical records to make a non-qualifying condition meet SSDI requirements
  • Failing to notify the SSA if your medical condition improves and allows you to return to work
  • Filing multiple SSDI applications in different states
  • Receiving benefits as the representative payee, but keeping the payments instead of providing the funds to the true beneficiary 

Essentially, trying to obtain Social Security disability benefits that you aren’t entitled to constitutes fraud. 

How Do Disability Fraud Investigations Get Started?

Most CDI investigations take place before the SSA awards benefits, although the program may also help investigate potential fraud in the Continuing Disability Review process. Most CDI investigations start when someone reports suspected fraud. 

Anyone can make a report of suspected fraud, but most reports come from SSA employees or state DDS employees. These employees may make a report of suspected fraud if they come across inconsistencies in a claim or suspect that an applicant may be lying.

During a disability fraud investigation, the CDI unit may contact the applicant’s doctors and record the applicant’s activities and statements. CDI units may reach out to third parties when looking for evidence of fraud. For example, if the CDI agent suspects that an applicant is faking their difficulties with walking, they may talk with neighbors to determine whether the applicant always uses a walker or wheelchair while at home.

What Happens to Fraudulent Claimants?

If the CDI determines that there is fraudulent activity, there are several actions they may take against the perpetrator:

  • Notifying federal or state prosecutors (penalties for a felony conviction include up to five years in prison and up to $250,000 in fines)
  • Imposing SSA sanctions
  • Pursuing monetary penalties in civil court

The potential consequences of committing SSDI fraud are severe.

How to Avoid Being Investigated for Social Security Disability Fraud

Unfortunately, not all CDI investigations center on people who are actually committing fraud. Sometimes legitimate applicants get investigated because the SSA makes a mistake or a civilian incorrectly suspects fraud and makes a report. 

While there’s no way to guarantee that you will never be investigated for SSDI fraud, you can avoid this circumstance by making sure all your documentation is complete and factual and following the application or appeals process correctly. Working with a disability benefits lawyer may reduce your risk of making unintentional mistakes that could cause an investigation.

Contact Michael Hartup for Help With Your SSDI Claim

If you have worked and paid your Social Security taxes and now have a disability that prevents you from earning income, you may qualify for SSDI benefits. However, the claims process can be stressful and overwhelming, and many eligible applicants have their initial claims denied due to preventable errors. Sometimes, mistakes in legitimate claims get investigated as fraud, which can be a frightening situation.At The Law Offices of Michael Hartup, we help Tennessee residents who are eligible for SSDI benefits navigate the claims process. We can help you understand the requirements and make sure you have all the necessary documentation for your claim. If your previous claim has been denied, we can walk you through the appeals process. To get started, contact us online or call our office in Jackson, Tennessee, at 731-424-5559.