TN 64 (02-24)

GN 02604.415 Referring a Potential Administrative Sanction Case to the Office of the Inspector General (OIG) - Field Office (FO) Procedure

A. Documenting a referral of a potential administrative sanction case

An OIG referral is mandatory after an SSA or a Disability Determination Services employee identifies a potential sanction case as described in GN 02604.410. Take the following steps to document a referral.

1. Compile documentation about the potential administrative sanction case

Compiled documentation must support your findings that the case meets the initial criteria for a potential administrative sanction case as defined in GN 02604.405. If your case might contain fraud or findings of similar fault, documentation must support this information as well.

IMPORTANT: SSA does not require a finding of fraud or similar fault to impose an administrative sanction. For more information on how administrative sanctions differ from fraud or similar fault, see GN 02604.405D.10.

See also:

GN 04020.010 Unrestricted Reopening for Determinations or Decisions Involving Fraud or Similar Fault

SI 04070.020 Fraud and Similar Fault - SSI

Documentation includes, but is not limited to, the following evidence:

  • The misrepresented information or the omission of a material statement on an SSA application or form;

  • Form SSA-5002 (Report of Contact) or RPOC screens that documents the person’s false statements.

  • Fraudulent or false documents that the person submitted as evidence;

  • Documentation that supports your conclusion that the person knowingly made a false or misleading statement or failed to disclose information, and that the person knew or should have known that the failure to disclose material information was misleading;

  • SSA records or reports that support your conclusion that the person knowingly submitted, or concealed, false or misleading statements, or documents;

  • SSA records that document the amount of any overpayment resulting from the misrepresentation or omission;

  • SSA records that document a prior determination of fraud or similar fault; and

  • Any other paper or electronic evidence that supports your finding.

2. Create a program integrity file

Establish and store all documentation in a temporary program integrity file as described in GN 04111.060.

B. Referring a potential violation to the Office of the Inspector General (OIG)

Forward the administrative sanction documentation and evidence to the OIG for its fraud investigation via the Allegation Referral Intake System (ARIS). Access the ARIS via IMAIN. Under the Fraud Allegation section, select 'Yes' that the case is a potential administrative sanction case.

C. Processing initial claim, post-entitlement, or post-eligibility actions

Consult with the OIG prior to completing any pending adjudicative or post-adjudicative actions. In addition, communicate with the OIG to determine case status and when to take administrative action. For more information on completing actions for potential administrative sanction cases, see GN 04111.010D.

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GN 02604.415 - Referring a Potential Administrative Sanction Case to the Office of the Inspector General (OIG) - Field Office (FO) Procedure - 02/20/2024
Batch run: 02/20/2024