TN 5 (10-09)

SI 02201.007 Supplemental Security Income (SSI): Overpayment Fraud

A. If you suspect the overpayment is the result of fraud

If you suspect that an overpayment was the result of fraud, stop or suspend all recovery efforts, including sending the initial overpayment notice, until:

  • You no longer suspect fraud, or

  • Your investigation does not result in a referral to the Office of the Inspector General (OIG), or

  • OIG returns the referral/case.

When one of the above conditions is met:

  • Send an initial overpayment notice showing the full period of, and the full amount of, the overpayment.

  • Resume recovery efforts.

If the OIG accepts your referral, do not begin or resume any recovery action until the OIG completes its processing.

B. Possibility of fraud discovered after the expiration of the period for reopening

  1. If the possibility of fraud as a cause of the overpayment is first discovered after the expiration of the period for reopening:

    • Limit the overpayment period and recovery efforts to the period that has been reopened under the rules of administrative finality. For information on administrative finality, see SI 04070.

    • Do not send the initial notice of overpayment until one of the conditions in SI 02201.007A are met.

    • When one or more of the conditions in SI 02201.007A are met,

    • Send an initial overpayment notice showing the full period of, and the full amount of, the overpayment and

    • Resume recovery efforts.

  2. If the OIG accepts your referral, do not begin or resume any recovery action until the OIG completes its processing.

  3. If the OIG has declined prosecution, a revised determination of overpayment is required. Send a revised initial overpayment notice showing the full period of the overpayment and the full amount of the overpayment.

C. Referral of fraud aspects to the OIG

If you refer the fraud aspects of the overpayment to the OIG,

  • Stop or suspend all recovery efforts.

  • Diary for 60 days for the OIG to review your fraud referral.

  • If the OIG completes its review before the 61st day and does not accept the referral, resume recovery efforts.

  • Send the initial overpayment notice.

  • Post the notice date (use the UOSD screen). For information on the use of the UOSD screen, see MSOM BUSSR 004.006.

    If by the 60th day the OIG notifies you either that its review is not complete; or, that it has accepted the case, do not begin or resume recovery efforts until the OIG either declines your referral or completes its processing of the accepted case.

    While the OIG is reviewing your referral or after the OIG accepts your referral, inform the OIG of any events that affect either the fraud issue or the overpayment. Some examples are a request for waiver, an offer of compromise settlement, or an offer of a refund. If by the 60th day OIG has not responded, request a status update from them.

D. References

  • MSOM BUSSR 004.006 - Update Sequence Data (UOSD)

  • SI 02220.000 - Recovery Procedures for Supplemental Security Income Overpayments

  • SI 02220.005 - Documenting the Supplemental Security Income (SSI) Overpayment

  • SI 02220.010 - SSI Overpayment -- Notifying the Individual

  • SI 02220.017- SSI Overpayment – Request for a Different Rate of Adjustment, Reconsideration or a Waiver

  • SI 02220.020 - Cross Program Recovery (CPR) of SSI Overpayments from Monthly Title II Benefits

  • SI 02220.030 - SSI Overpayment – Compromise Settlement

  • SI 04070.000 - Administrative Finality – SSI


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502201007