The following are some examples of situations in which a finding that the person knowingly provided false or misleading information or failed to disclose material information may be appropriate. REMINDER: Each potential sanction situation is unique, and the outcome of a particular case and factors not summarized below may influence the case.
EXAMPLE 1. After we deny an SSI claim, a person applies for benefits in another office. In the second SSI application, he omits a significant resource that he reported in the first application so that we will approve the claim.
EXAMPLE 2. A person presents altered documents in support of a claim, or uses someone else’s document that she represents as her own.
EXAMPLE 3. After SSA requests that an SSI claimant report all income and resources, he reports one bank account with a balance of $1,000, but fails to report another bank account with a balance of $15,000, which we discovered through the Access to Financial Institutions (AFI) process.
EXAMPLE 4. Someone other than the claimant takes part in a redetermination or a medical examination on behalf of the claimant, while holding himself out to be the claimant. We may also sanction the claimant if he or she is aware of the deception.
EXAMPLE 5. A claimant reports that she is not working in response to a request for such information, but an observation reveals her working for a period of time that overlaps with the work report.
EXAMPLE 6. A claimant alleges and exhibits physical impairments during an interview in a field office (FO), but an observation reveals the claimant taking part in activities that are clearly inconsistent with the alleged impairments. During the interview, he uses a wheelchair or crutches for an impairment that would limit a wide range of activity. Shortly thereafter, an observation reveals the claimant participating in vigorous physical activity without the wheelchair or crutches.
EXAMPLE 7. A claimant reports that she is living at an address, which we later verify is a vacant lot. The FO then determines that the claimant is living outside of the country. This report may constitute both a false statement and a failure to report living outside the country.
EXAMPLE 8. A claimant misrepresents or omits information regarding his living arrangement. The claimant asserts that he is living alone after we advise him of the income rules and income deeming at the time of application and again during redetermination reviews. FO personnel verify that the claimant did not live alone during the time of the representations. They also verify the other person living with the claimant had income that would affect the claimant’s payment amount.
EXAMPLE 9. We suspend an SSI recipient’s payment because he left the country for more than 30 days. He leaves the country again for more than 30 days but omits this information when asked during a subsequent redetermination interview.
EXAMPLE 10. A Title II beneficiary alleges that he has an illegitimate child and claims benefits for that child. Evidence reveals that the beneficiary is not the father and that he knowingly made a false statement in order to gain additional benefits on behalf of the child.
EXAMPLE 11. A beneficiary reports a nonreceipt of her original check. SSA issues a replacement check and the beneficiary cashes both checks. Evidence indicates the beneficiary knowingly and falsely stated that she did not receive the original check. We may impose a sanction for that false statement. We may also impose a sanction for a failure to report the receipt of a duplicate check if the evidence supports a finding that the person knew or should have known that failure to disclose receipt of a duplicate check was misleading.
EXAMPLE 12. A person receiving benefits for having a child in care neglects to report that the child intermittently leaves her care. We determine that not having a child in care would affect her benefits.
EXAMPLE 13. A disability beneficiary, whose benefits we partially offset due to the receipt of workers' compensation (WC), neglects to report an increase in his WC payment amount. At the time we awarded the claim, we advised the beneficiary that he must report any change in his WC payments.
EXAMPLE 14. A disability beneficiary fails to report that she returned to work. The award letter informed the beneficiary that she must report future work.
EXAMPLE 15. When applying for spouse’s benefits, a claimant falsely answers that he does not qualify for a pension based on non-covered employment. Several years later, the number holder (the claimant’s wife) informs us that her husband is entitled to a pension based on his non-covered employment and that he had been entitled, in fact, since before he claimed his spousal benefits. SSA should have applied the Government Pension Offset to reduce his spousal benefit through the life of his claim.
EXAMPLE 16. A claimant for retirement benefits falsely answers that he is not entitled to a pension based on non-covered employment. Several years later, SSA becomes aware that at the time of claiming Social Security retirement benefits he was in fact entitled to a pension based on non-covered employment from the State of Ohio. SSA should have applied the Windfall Elimination Provision to reduce his retirement benefit amount.