In this section, see examples of sanction determinations when we decide to impose a sanction and not to impose a sanction. These are examples of how to document a sanction determination, not when to sanction a case.
EXAMPLE 1: decision to impose a sanction
Did John Doe Jones (SSN 000-00-0000), willfully and knowingly provide false or misleading information to SSA by denying work activity, concealing earnings and concealing a marriage, which could create an overpayment from April 2014 through May 2016?
Per 20 CFR 416.1340, the purpose of this determination is to address whether SSA should impose an administrative sanction against John Doe Jones based on concealing earnings, marriage, and work activity.
FO XXX referred this Title XVI case to the OIG for potential sanction.
This case includes a Category 2 CMP factor.
Unscheduled redetermination (RZ) initiated 06/01/2016 when John Doe Jones visited FO XXX for a benefit verification letter.
During the RZ interview, two years of earnings present on new hire query despite SSI records showing the recipient was not currently working and hadn't worked since 2011.
Employer, ABC Staffing, Inc. (EIN # XX-XXXXXXX), listed on the new hire query, has never been included on John Doe Jones' detailed earnings query.
Claimant was evasive and defensive when asked about working for ABC Staffing.
Contact made with ABC Staffing and employer provided verification of earnings on L4201 dated XX/XX/XXXX.
Medical continuing disability review (CDR) initiated per the OIG's request 07/01/16. Medical continuance issued 09/10/16.
Additional allegation referred to the OIG by DDS for uncooperative and evasive behavior during consultative exams.
Concealment of marital status revealed during medical consultative exam, which is being addressed in the current RZ; marriage date 03/06/14.
John Doe Jones and employer made multiple attempts to revise original report of wages. All reports are inconsistent.
ROI confirmed marriage date.
OIG included the closing memorandum.
John Doe Jones made conflicting statements on multiple occasions in multiple field offices regarding work activity and marital status. All statements appear potentially fraudulent. No evidence shows that Mr. Jones did not understand what he was reporting. Therefore, it is determined he knowingly made these false and misleading statements. Decision to impose an administrative sanction based on ongoing concealment, evasiveness, manipulation of information, and conflicting statements made to SSA and authorities with the intention to defraud the programs in place. Overpayment for $18,962.97 created by false claims and concealment of information. This is Mr. Jones' second occurrence. The sanction period is 12 months.
Social Security Act, as amended in 2004 (P.L. 108-203), §1129A [42 U.S.C. 1320a–8a]; Regulations 20 CFR 404.459 and 416.1340
Determination Made By: (Name), Claims Specialist, Date: XX/XX/XXXX
Approved By: (Name), Claims Technical Expert, Date: XX/XX/XXXX
EXAMPLE 2: decision not impose a sanction
Did Jane Doe Jones (000-00-0000), representative payee for Supplemental Security Income (SSI) recipient Frank Doe Jones (000-00-0000), willfully and knowingly withhold information about his incarceration from Social Security and continue to receive his benefits from July 2014 through November 2017, totaling $30,003.00?
Per 20 CFR 416.1340, the purpose of this determination is to address whether SSA should impose an administrative sanctions against Jane Doe Jones based on her failure to report changes that affect Frank Doe Jones' SSI eligibility and payment.
FO XXX referred this Title XVI case to OIG.
This case includes a combination of Category 2 and 3 CMP factors.
SSA did not receive a PUPS alert for Frank Doe Jones.
Jane Doe Jones has been Frank Doe Jones' payee since 08/14/2006.
Frank Doe Jones was previously overpaid $14,499.00 due to incarceration from 09/2009-11/2011. SSA collected the overpayment in full.
Payee provided a personal bank statement, from 02/22/2018-03/20/2018 showing a balance of $31,686.47. It appears to be a joint account. Frank Doe Jones' SSI benefits were being deposited into the same account. The account title is in Frank Doe Jones' name only; $30,003.00 was returned to SSA on 05/14/2018.
The Claims File User (CFUI) document 09/08/2014 from Jane Doe Jones dated 07/19/2014 requesting SSA to stop Frank's checks due to his incarceration. His release date unknown.
CFUI 12/22/2014 scanned document received from Frank Doe Jones. In the document, he states that he was incarcerated and requests that SSA stop his checks.
SSA received a letter from Frank Doe Jones from jail 12/16/2014, scanned to CFUI 01/01/2015. Letter requested that SSA stop his SSI benefits.
Representative payee completed representative payee accounting forms. Payee stated that there were no conserved funds 09/01/2014-08/31/2016 and only $812 is being saved for 09/01/2016-08/31/2017. There was no mention of Frank’s incarceration on the accounting forms.
Payee accounting forms indicates that the only money that has been saved was $812. However, claimant's bank account statement has $31,686.47.
SSA imposes a sanction when a person makes (or causes to be made) a statement or representation of a material fact for use in determining any initial or continuing right to, or the amount of, monthly insurance benefits under Title II or benefits or payments under Title XVI, if:
The statement or representation is false, misleading or omits a material fact which makes it false or misleading; and
He or she knows or should know the statement or representation is false, misleading, or omits a fact that the person knows or should know is material and knows or should know that the omission of the fact makes the statement misleading, or the person makes such a statement or representation with a knowing disregard for the truth.
After reviewing the evidence in file and the reasonable inferences that can be drawn, there is insufficient evidence that Jane Doe Jones or Frank Doe Jones knowingly omitted facts that were material for Frank Doe Jones' SSI benefits. Both parties reported the incarceration to the agency. No administrative sanctions imposed. Advised payee to change direct deposit to an account with an acceptable account title. Also, advised payee that, in the future, use the remarks section of the rep payee accounting form to report any changes that would affect Mr. Jones' eligibility for benefits, or the payment amount.
Section 201 of the Social Security Protection Act of 2004 (P.L. 108-203) broadened the range of actions that cause a sanction to include failure to report an event that is material to the eligibility or benefit amount if the person knows or should know that failure to report is misleading.
Determination Made By: (Name), Claims Specialist, Date: XX/XX/XXXX
Approved By: (Name), Regional Sanctions Coordinator, Date: XX/XX/XXXX