Identification Number:
EM-19030
Intended Audience:All RCs/ARCs/ADs/FOs/OARO
Originating Office:DCO OPSOS
Title:SSI Termination Policy When Reopening Due to Fraud or Similar Fault Results in a Past Period of Ineligibility of at Least 12 Consecutive Months – One-Time-Only Instructions
Type:EM - Emergency Messages
Program:Title XVI (SSI)
Link To Reference:See References at the end of this EM.
 
Retention Date: April 28, 2020

A. Purpose

This emergency message (EM) clarifies policy and provides guidance on how to treat the termination of Supplemental Security Income (SSI) records that involve fraud or similar fault (FSF) when we discover a past period of ineligibility of at least 12 consecutive months. It also ensures that we terminate records and process overpayments properly when we detect FSF.


    This EM will remain in effect until we update appropriate POMS sections.

B. Background

    SSI recipients (or their representative payees) are responsible for reporting changes that may affect their eligibility or payment amount. Lack of timely reporting may lead to overpayments or ineligibility (see SI 02301.005 for more information on SSI posteligibility reporting responsibilities). Section SI 02301.205D instructs technicians to continue paying SSI recipients who are currently eligible when we retroactively suspend benefits for 12 (or 24) consecutive months. These instructions apply in most cases related to reopenings under the 1-year rule or for good cause under the 2-year rule. (see SI 04070.010F).

    However, different rules apply when we reopen based on a fraud or similar fault (FSF) determination as described in SI 04070.020 and SSR 85-23. Additionally, if we detect similar fault during the development of an overpayment, we can make a similar fault determination and reopen the prior initial determination(s) for the entire period of the overpayment.


C. Policy

    When a revised determination or decision is a past period of ineligibility of at least 12 consecutive months and you are applying unrestricted reopening as described in SI 04070.020 to reopen the initial determination or decision due to FSF, you must terminate benefits effective with the start of the first 13th consecutive month of suspension.

    Example: John Doe left the United States for an unreported period from 07/15/2010-11/30/2011. He had an SSI redetermination (RZ) on 12/01/2011 and did not report any period of absence. He remained in the U.S. through 06/01/2014 when the Office of Inspector General informed us of an investigation that concluded that Mr. Doe knowingly failed to report his absence from the United States. Because John Doe knowingly concealed information that was material to the deemed initial determinations during the months he was absent from the United States, these determinations were obtained by similar fault and must be reopened and revised. The result would be at least 12 consecutive months of retroactive suspension due to absence from the United States. Therefore, SI 02301.205D does not apply and the technician must retroactively terminate benefits and calculate an overpayment beginning 08/2010 despite John Doe’s current eligibility status.

    Reminder: SSI cases involving FSF are entitled to due process protections, including appropriate notices and Goldberg-Kelly processing. For more information, refer to SI 04070.050 and SI 02301.300


Direct all program-related and technical questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns or problems to their Central Office contacts.

References:

SI 02301.005 SSI Posteligibility – Recipient Reporting
SI 02301.205 Suspension and Reestablishing Eligibility
SI 02301.300 Due Process Protections – General
SI 04070.010 Title XVI Administrative Finality - Reopening Policies
SI 04070.020 Fraud and Similar Fault - SSI
SI 04070.050 Notice of Revised SSI Determination or Decision
GN 04105.005 Violations of the Social Security Act
20 CFR 416.1335 Termination due to continuous suspension
SSR 85-23 Title XVI: Reopening Supplemental Security Income Determinations at Any Time for “Similar Fault”


EM-19030 - SSI Termination Policy When Reopening Due to Fraud or Similar Fault Results in a Past Period of Ineligibility of at Least 12 Consecutive Months – One-Time-Only Instructions - 10/28/2019