TN 2 (06-08)
DI 27505.015 Fraud or Similar Fault - Reopenings
For the definition of the term “fraud,” please see GN 04105.005B.
Unrestricted Reopening - The Determination or Decision Was Procured by Fraud or Similar Fault (GN 04020.010), and
Title XVI Administrative Finality Definitions – Fraud (SI 04070.005A.11.).
B. Similar Fault
For the definition of the term “similar fault,” please see GN 04105.005B.
C. Operating Guidelines Where Fraud or Similar Fault is Uncovered in a Prior Favorable Determination or Decision
1. When an Office Other than the Disability Determination Services (DDS) Uncovers Fraud or Similar Fault
The office that uncovers the fraud or similar fault issue refers the case to the DDS.
2. When DDS Uncovers or Receives a Case with a Fraud or Similar Fault Issue
a. If the DDS is Located in an Area Where a Cooperative Disability Investigations (CDI) Unit Exists
Refer the case to the CDI unit.
Follow Suggested Development Techniques (DI 23025.020). A referral to the CDI unit requires management approval as explained in Preparation of the Electronic Form SSA-8551 (e8551) (GN 04111.065A.5.a.).
b. If the DDS is Located in an Area Where a State Fraud Investigation Unit (FIU) Exists
Refer the case to the FIU, using local DDS procedures.
See Special Handling of Cases That Are High Risk for FSF (DI 23025.015).
3. When it is Determined that a Prior Favorable Determination or Decision Warrants Reopening Due to Fraud or Similar Fault
a. If DDS Has the Authority to Reopen
Reopen per Reopening and Revising a Determination or Decision – Operating Policy-Who May Reopen (DI 27501.005B.3.);
Complete the disability determination actions, including reopening and revising the prior determination; and
Send the case to the Office of Disability Operations (ODO) or the appropriate Processing Center (PC).
Refer to Disregarding Evidence (DI 23025.025) for pre-effectuation review.
b. If a Disability Hearing Unit (DHU) or the Office of Medical and Vocational Expertise (OMVE) Made the Prior Determination
Send the case to the DHU or OMVE, as appropriate.
c. If an Administrative Law Judge or the Appeals Council Made the Prior Decision
Send the case to ODO or the PC, as appropriate.