The mere fact that the person makes a false statement or fails to disclose material
information does not justify imposition of a sanction. You must also find, based on
the reasonable inferences you draw from the evidence, that the person acted knowingly
in making the false statement or in failing to disclose information, and that the
person knew or should have known that the failure to disclose material information
We do not impose administrative sanctions solely because of the type of event (like
a double check negotiation). In addition, sanctions do not apply to potential fraud
situations involving applications for Social Security numbers.
Consider the significance of the false, misleading, or omitted information in terms
of its likely impact on the person’s benefits to determine if the person acted knowingly
(see GN 02604.410).
In general, the less significant the false statement is in terms of its likely impact,
the less likely it is that the person knew or should have known it was false or misleading.
Consider conditions on a case-by-case basis.
Consider the significance of the false, misleading, or omitted information when deciding
whether to pursue further evidentiary development.
While the amount of an overpayment caused may be relevant to determining whether the
person acted knowingly, the law and regulations do not set a “tolerance” for the amount
of money that has to be involved to justify a sanction. Depending on the circumstances,
it may be appropriate to impose a sanction even though the false or misleading statement
or failure to disclose creates an overpayment that is less than the amount of benefits
we would sanction.
IMPORTANT: The Office of the Inspector General must review all cases for potential fraud before
we impose administrative sanctions.