TN 23 (01-17)

GN 02604.415 Referring a Potential Administrative Sanctions Case to the Office of the Inspector General (OIG) - Field Office (FO) Procedure

A. Documenting a referral of a potential administrative sanction case

An OIG referral is a required step after an SSA or Disability Determination Services employee identifies a potential sanctions case as described in GN 02604.410. Take the following steps to document a referral.

1. Document the potential administrative sanction case

Document the case to support your findings that:

  • the case meets the initial criteria for a potential administrative sanction (see GN 02604.405); and

  • a person might have attempted or committed fraud by knowingly making a false or misleading statement or withholding material information with the intent to defraud.

Documentation includes, but is not limited to, the following evidence:

  • The misrepresented information or the omission of a material statement on an SSA application or form;

  • Form SSA-5002 (Report of Contact) or RPOC/DROC screens that documents the person’s false statements. Include statements he or she made on or after 12/14/99, as well as current statements.

  • Fraudulent or false documents that the person submitted as evidence;

  • Documentation that supports your conclusion that the person knowingly made a false or misleading statement or omission;

  • SSA records or reports that support your conclusion that the person knowingly submitted, or concealed, false or misleading statements, or documents;

  • SSA records that document the amount of any overpayment resulting from the misrepresentation or omission;

  • SSA records that document a prior determination of fraud or similar fault; and

  • Any other paper or electronic evidence that supports your finding.

2. Create a program integrity file

Establish a program integrity file, which is separate from the claims folder. Applicants, beneficiaries, recipients, and representative payees have the right to access all information pertaining to them in government records, except program integrity records. For instructions on establishing a program integrity file, see GN 04111.060.

B. Referring a potential violation to the Office of the Inspector General (OIG)

1. Refer the case to OIG

Forward the administrative sanctions documentation and evidence to OIG for its fraud investigation by using the electronic e8551 (Reporting Form for Programmatic Fraud). Access the electronic form at e8551 Fraud Entry Form.

IMPORTANT: We do not require a finding of fraud to impose an administrative sanction. For more information on how administrative sanctions differ from fraud, see GN 02604.405D.10.

When referring a potential administrative sanctions case to OIG, annotate section E of the “Summary” section of the e8551, that the case is a potential administrative sanctions case.

2. Refer the case to the regional administrative sanctions coordinator

Forward copies of the e8551 and supporting documentation to the designated regional sanctions coordinator (RSC). The RSC will evaluate whether the case meets the initial criteria for a potential administrative sanction.

C. Processing initial claim, post-entitlement, or post-eligibility actions

While OIG evaluates the case, continue to process initial claim, post-entitlement (Title II) or post-eligibility (Title XVI) actions. For EXAMPLE, obtain evidence for claim processing or process work reports for redeterminations.

D. References

  • GN 04020.010 Unrestricted Reopening for Determinations or Decisions Involving Fraud or Similar Fault

  • SI 04070.020 Fraud and Similar Fault - SSI

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