For definitions of the terms “fraud” and “similar fault” refer to GN 04105.005B.
The Group II exception for FSF applies when a prior favorable determination or decision was obtained by FSF. If we find that any prior
favorable or partially favorable decision was obtained by FSF, we may find that the
beneficiary or recipient is not disabled. In addition, we may reopen the prior determination
on the remaining evidence.
At the time of a CDR, if the adjudicator discovers potential FSF was involved in a
prior favorable determination or decision, the adjudicator must follow the FSF referral
policy and procedures, see DI 23025.015. The adjudicator must complete appropriate
FSF development and referral procedures before making the determination that the Group
II FSF applies.
If there is not a previous referral or report from the Office of Inspector General
(OIG) or the Cooperative Disability Investigations Unit (CDIU) for the prior determination
or decision in question, the adjudicator must complete a referral through the Allegation
Referral Intake System (ARIS), see DI 23025.010B.2.
This exception does not apply when FSF is involved only in the pending CDR. In this situation; follow the
FSF instructions in DI 23025.000. When FSF occurs in the pending CDR, disregard evidence
obtained by FSF and make a determination on the remaining evidence. This may result
in either a cessation or a continuance determination.
Reference:
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DI 23025.000 Fraud or Similar Fault
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DI 23027.000 Disability Determination Services (DDS) - Fraud and Similar Fault (FSF)
Redeterminations
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