SSA refers a person suspected of fraud or other misconduct to the Office of the Inspector
If OIG investigates and validates that fraud or other misconduct occurred, it refers
the matter to the U.S. Attorney to consider an action for civil or criminal false
statements and related misconduct.
If the U.S. Attorney declines to prosecute and issues the formal “declination” required
by statute, OIG may refer the case to its Office of the Counsel to the Inspector General
(OCIG) to consider imposing a Civil Monetary Penalty (CMP) and any assessment.
If OCIG determines the case meets the legal requirements for a CMP, it contacts the
individual by mail to advise it is considering a CMP and to request the individual
to provide information regarding his or her financial circumstances.
If the individual responds, OCIG may attempt to negotiate a reasonable settlement,
in light of the individual’s financial circumstances, the seriousness of the offense,
and other aggravating or mitigating circumstances specified by Congress in the statute.
If the person does not respond, OCIG sends the individual a second notice that addresses
any known information about the individual’s financial and other circumstances and
proposes to impose the CMP. The notice advises where the individual should send payment
and how to request review of the fine.
Thereafter, the individual has 60 days to seek review of the proposed action and request
a hearing by the U.S. Department of Health and Human Services’ (HHS) Departmental
Appeals Board (DAB) in Washington, D.C.
If the individual does not seek review within 60 days, OCIG relies upon the record
information that is available and notifies the individual of its decision to impose
a CMP. The notice imposing a CMP includes a demand for payment.