Fraud exists when a person with the intent to defraud, either makes or causes to be
made, a false statement or misrepresentation of a material fact for use in determining
rights under the Social Security Act; or conceals or fails to disclose a material
fact for use in determining rights under the Social Security Act.
2. Similar Fault
Similar Fault is involved with respect to a determination if an incorrect or incomplete
statement that is material to the determination is knowingly made or information that
is material to the determination is knowingly concealed.
3. Preponderance of the Evidence Standard
Preponderance of the evidence means such relevant evidence that as a whole shows that
the existence of the fact to be proven is more likely than not.
Preponderance is established by that piece or body of evidence that, when considered,
produces the stronger impression and is more convincing as to its truth when weighed
against the evidence in opposition. Thus, preponderance does not require that a certain
number of pieces of evidence (e.g. five or six) must be present. It is possible that
just one piece of evidence may be so convincing that it outweighs more than one piece
of evidence in opposition.
We may reopen a determination or decision when a preponderance of the evidence shows
that a determination or decision was obtained by FSF. For continuing disability reviews
(CDRs), the Group II exception to the medical improvement review standard (MIRS) applies
when a favorable determination or decision was obtained by FSF. See DI 28020.900 Group II Exceptions.
GN 04020.010 Unrestricted Reopening - Determinations or Decisions Obtained by Fraud
or Similar Fault
GN 04105.005 Violations of the Social Security Act