When a federal court convicts a beneficiary of fraud that involves concealment of work activity, they are not eligible to receive payments for any TWP months performed in or after March 2004, and before the date of conviction. For information about allegations of fraud and the TWP see DI 13010.035.

NOTE: The beneficiary is still entitled to a TWP even though they are not eligible for payment of benefits during the TWP months covered by the conviction court order.

Once the court convicts the beneficiary, forward all TWP fraud cases to the SSA OCO OMOS Security and Integrity Branch (OCO SIB) for effectuation. If you receive a TWP fraud case in the FO, immediately refer the case via email to: ||OCO Integrity Branch. The email should include the following:

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  the SSN;

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  a brief but detailed description of the issue;

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  email subject line should read "A TWP fraud determination is required"; and

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  all court documents and all other relevant documentation if applicable (i.e., Judgement in a Criminal Case (JCC), Report of Court Ordered Restitution/Judgement (Form OI-68)).

Please refer to ISP Section 3.3.5 for more information on Secure Email and Fax Use Policy.

If a TWP fraud case is received in the PC, send the case, via the Paperless System, to: I-II PDA PROC. The ACR should include the following:

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  the SSN;

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  a brief but detailed description of the issue;

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  the statement "A TWP fraud determination is required"; and

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  all court documents and all other relevant documentation if applicable (i.e., Judgement in a Criminal Case (JCC), Report of Court Ordered Restitution/Judgement (Form OI-68)).

  Note: 

  Upload any new evidence or documentation to eView or Evidence Portal (EP).

  If the case is a paper folder send an email to: ||OCO Integrity Branch for routing instructions.

  If there is a need to follow-up, send an email to: ||OCO Integrity Branch.

When convicted of fraud, the beneficiary may not be eligible for payment for certain service months of the TWP. When considering nonpayment TWP months:

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  The beneficiary is still entitled to a TWP even though they are not eligible for payment of benefits during the TWP months covered by the conviction court order. We continue to pay all auxiliaries on the account when the beneficiary is suspended, but we do not readjust benefits for a family maximum for TWP fraud suspension.

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  The beneficiary is liable for repayment if we paid them for TWP months that we should not have. The amount of the overpayment is subject to appeal but is not subject to waiver rights.

NOTE: These procedures may occur in conjunction with or in addition to the administrative sanctions. For more information on administrative sanction procedures, see DI 11006.030. For information about concealed work activity during the date of disability onset, see DI 11006.015C. For information on when to terminate Medicare coverage see HI 00820.025.

OCO SIB uses the disability control file (DCF) to record and effectuate the suspension of TWP fraud months. This process eliminates the need for a post-entitlement system (POS) input. The DCF initiates a T2 Redesign input that results in the suspension of disability benefits, and updates the master beneficiary record (MBR) for the TWP months that are not payable based on the fraud conviction. For more information on how TWP fraud months are posted to the MBR, see SM 00510.213 and SM 03005.285.

Since the DCF generates a suspension action:

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  The field office (FO) or processing center (PC) should never initiate or change the DCF verified (VRFD) “F” coding for a TWP fraud determination.

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  OCO SIB inputs all DCF suspension or reinstatement coding for TWP fraud cases.

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  The FO or PC may process subsequent work actions on a TWP fraud case, as long as there is no change to the TWP fraud coding.

You can use the eWork program to document the TWP and extended period of eligibility (EPE) SGA months; however, the process of coding the DCF to effectuate the suspension of the TWP fraud months is a manual process.

From the DCF menu, select The Verify/Update Earnings (VERN) screen for the first TWP month that is not payable due to the fraud conviction.

On VERN screen:

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  Input the conviction date into the FRAUD DECISION DATE field (MMDDCCYY);

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  In the VRFD field over key the “Y” with an “F”;

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  Use the PF8 function to input additional TWP months that are not payable, and over key each “Y” with an “F”;

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  Hit ENTER when you have recorded all of the non-payable TWP months covered by the fraud conviction. Since this action initiates a payment change, you will need to confirm your action by clicking PF9; and

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  Release notice (see subsection D in this section for notice language).

If we did not record the TWP months as part of a previous work review, input the FRAUD DECISION DATE, and record the “F” in VRFD field and the appropriate WORK DET code (‘1’ through ‘9’).

OCO SIB sends a manual notice to the beneficiary that includes paragraph TWP010. The notice explains why we cannot pay the beneficiary benefits for the TWP months. The notice should include appeal rights, but does not include a waiver right paragraph. For information on title II overpayments, see GN 02201.009.

TWP010 states:  Section 222(c)(5) of the Social Security Act provides that a person who is convicted by a Federal court of fraudulently concealing work activity during the trial work period, will not receive benefits for any months of work activity during the trial work period that occur on or after March 2004 and are before the date of conviction. You are not due benefits for the following trial work period months: (list the non-payable months of the TWP).