If fraud is suspected, complete all development for the entire period except the determination
that fraud exists and refer the case to the Office of Investigation Field Offices
(OIFO) (formerly regional OIG) in accordance with the instructions in GN 04020.010 – Unrestricted Reopening – The Determination or Decision Was Procured by Fraud or
Similar Fault. If OIFO notifies us that fraud exists, unlimited reopening is available,
even if the fraud is not prosecuted in a criminal proceeding. Normally, OIFO will
notify us that fraud exists only if there is a conviction for fraud. If OIFO determines
that fraud does not exist, unlimited reopening based on fraud is not available, and
the FO must consider the possibility of similar fault. (See SI 04070.020B.) The FO, and not OIFO, makes similar fault determinations.
NOTE: When making a fraud or similar fault determination, take into account the recipient’s
physical, mental, educational, or linguistic limitations, including any lack of facility
with the English language.
1. Overpayments within the administrative finality period
Usually systems input of factors that affect payment will result in issuance of the
appropriate automated notice. In all cases which require manual notices, send the
appropriate notice of revised determination which advises the recipient of his/her
appeal rights (either SSA-L8100-U2 or SSA-L8155-U2). Then follow procedures in the
following sections to recover the overpayments: SI 02201.000 – Supplemental Security Income Overpayments - Overview, SI 02220.000 – Recovery Procedures for Supplemental Security Income Overpayments, GN 02201.005 – Recalculating a Title II Overpayment Amount Due to Additional Benefits Payable,
GN 02210.001 – Adjustment of Overpayments, GN 02215.000 – Method of Recovery for Title II, Title XVIII, and SM 01310.001 – Introduction to
the SSI System’s Process for Overpayments/Underpayments.
2. Overpayments made before 2-year period
After OIFO makes a determination of fraud or the FO makes a determination of similar
fault, follow the same procedures to recover the overpayment as described in SI 04070.020A.1.