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This article was co-authored by Clinton M. Sandvick, JD, PhD. Clinton M. Sandvick worked as a civil litigator in California for over 7 years. He received his JD from the University of Wisconsin-Madison in 1998 and his PhD in American History from the University of Oregon in 2013.
There are 11 references cited in this article, which can be found at the bottom of the page.
This article has been viewed 51,622 times.
State and federal programs offer income-replacement benefits to people with short-term or permanent disabilities. The Social Security Administration (SSA) administers the federal government's Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs.[1] Additionally, a few states like California administer their own short-term disability programs.[2] If you suspect that someone is committing disability fraud, then you can report the abuse.
Steps
Part 1
Part 1 of 2:
Recognizing Fraud
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1Learn the federal eligibility requirements. To be eligible for federal disability benefits, an individual must have a qualifying disability. This means that the individual must be unable to engage in "substantial gainful activity" for at least 12 months.[3] Moreover, the Social Security Administration considers individuals disabled if these three elements are met:
- They cannot do the work they did before
- They are unable to work because of a medical condition
- The disability has lasted or is expected to last for at least one year or result in death.[4]
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2Learn state eligibility requirements. A few states offer state disability insurance benefits.[5] These programs offer temporary benefits to employees for wages individuals have lost due to injury or sickness. Generally, individuals are considered "disabled" if they are unemployed due to illness or injury.
- States that run disability programs include California, Hawaii, New Jersey, New York, and Rhode Island.
- The eligibility requirements will vary by state, so be sure to check with your state disability insurance program for more detailed information.
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3Confirm that the individual is drawing disability benefits. Not everyone who stops working because of a claimed injury is drawing federal or state benefits. Many employers offer private short-term disability insurance. Alternatively, the person could be taking extended sick leave.
- Ask yourself how you know the person is drawing federal or state benefits. Has the individual told you so? Have you seen documentation from either the state or federal agency?
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4Understand what constitutes fraud. SSA defines fraud in several ways. One form of fraud is making misrepresentations on an application. For example, an applicant may claim to be single on an application when in fact the applicant is married. Other forms of fraud include:
Part 2
Part 2 of 2:
Reporting the Alleged Disability Fraud
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1Document the alleged fraud. You will need evidence that the person claiming benefits has committed fraud to obtain them. Examples of fraud include wrongfully claiming a debilitating back injury but performing heavy-duty construction work, or failing to report workers’ compensation benefits while receiving disability benefits. You will need the following evidence:
- Description of the activity (e.g., performing heavy labor or running around)
- Location where you observed the activity
- The time and date
- How the fraud was committed
- Why the person has committed fraud (if known)
- Who else has knowledge of the fraudulent activity
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2Obey the law. As you gather evidence, be sure not to break the law. There is no reason to trespass, open someone’s mail, hack into someone’s computer, or snoop in order to get evidence.
- It is against federal law to open someone’s mail without permission.[8] You are not permitted to open an adult child’s mail simply because you are a parent.
- The legality of videotaping someone without their consent depends on state law. Generally, if the person is in public space, then you may videotape them. People have no expectation of privacy when they are walking in public, standing in their driveway, or sitting on their porch.
- Thirteen states prohibit using a camera in private places, such as someone’s home. These states include Alabama, Arkansas, California, Delaware, Georgia, Hawaii, Kansas, Maine, Michigan, Minnesota, New Hampshire, South Dakota, and Utah.[9] In other states, such as New Jersey, videotaping someone in private could subject you to a civil suit for intrusion or invasion of privacy.[10]
- Rather than videotape someone and risk being sued, you could simply document in writing the day and time you noticed the activity. Once you have notified SSA or a state agency of the suspected fraud, you can then leave it to the agencies to investigate further.
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3Choose a method of reporting. You can report to the federal SSA either online, by phone, or through the mail. You will have to choose a reporting “status”: either anonymous, confidential, or neither. If you report anonymously, then SSA will not be able to contact you. If you report confidentially, then SSA can follow up with questions but will not release your name or contact information unless required by a court. If you choose neither option, then SSA is free to release your name.[11]
- Report online. You can submit an online form by clicking here. After choosing your filing status, complete the remainder of the form which includes space for you to explain why and how you think someone has committed disability fraud.
- Report by phone. SSA runs a hotline you can call, at 1-800-269-0271. Hours are between 10:00 a.m. and 4:00 p.m. Eastern Standard Time. Also, you may report fraud by calling any Social Security office or by calling the SSA’s toll-free number at 1-800-772-1213 any time from 7:00 a.m. to 7:00 p.m.
- You can report suspected fraud through the U.S. mail or by fax. Send the names, addresses, telephone numbers, dates of birth, and social security numbers (if known) of the alleged suspect to Social Security Fraud Hotline, P.O. Box 17785, Baltimore, Maryland 21235 or via fax to 410-597-0118.
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4Report to a state agency. The fraud reporting requirements for state agencies will differ by state, so be sure to contact your state disability insurance program for specific information. State agencies administer their own funds, so reporting to the SSA is not enough to notify state agencies.
- In California, for example, you can submit an online fraud report, in which you report information about the alleged fraud. You may also call the Employment Development Department's fraud tip line at 1-800-229-6297. You will report similar information as you would report to the federal government: the name and contact information of the alleged offender, your reasons for suspecting fraud, and the name and contact information of the suspect’s employer and doctor.
- In New Jersey, you can report fraud using this online form. Or you can report by calling 609-984-4540 or by mailing information to Division of Temporary Disability Insurance, P.O. Box 387, Trenton, NJ 08625-1692. Include as much information as you know about the suspected fraud.
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5Answer follow-up questions. If the federal or state agency contacts you for further information, then provide any information or documents that they request promptly. Keep copies of any documents you send.
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6Seek whistleblower protection if necessary. If you are an SSA employee and you report what you reasonably believe are violations of law or regulation, including gross mismanagement or abuse of funds, then you are protected against retaliation.[12]
- If you believe that you have been a victim of retaliation, you should contact the U.S. Office of Special Counsel, either by phone at 1-800-872-9855 or by mail at 1730 M Street, N.W., Suite 218, Washington, DC 20036.
References
- ↑ http://www.ssa.gov/disabilityssi/
- ↑ http://www.edd.ca.gov/disability/
- ↑ https://www.law.cornell.edu/uscode/text/42/423
- ↑ http://www.ssa.gov/planners/disability/dqualify4.html
- ↑ http://www.nolo.com/legal-encyclopedia/state-short-term-disability-benefits
- ↑ http://oig.ssa.gov/concealing-facts-or-events-which-affect-eligibility-social-security-benefits
- ↑ http://oig.ssa.gov/what-abuse-fraud-and-waste/bribery-social-security-administration-employee
- ↑ https://www.law.cornell.edu/uscode/text/18/1702
- ↑ http://www.randolphwolf.com/blog/criminal-and-civil-liability-for-recordings/
About This Article
Clinton M. Sandvick, JD, PhD
Doctor of Law, University of Wisconsin-Madison
This article was co-authored by Clinton M. Sandvick, JD, PhD. Clinton M. Sandvick worked as a civil litigator in California for over 7 years. He received his JD from the University of Wisconsin-Madison in 1998 and his PhD in American History from the University of Oregon in 2013. This article has been viewed 51,622 times.
Co-authors: 7
Updated: February 19, 2023
Views: 51,622
Categories: Disability Forms Permits and Benefits
Article SummaryX
If a person receives disability benefits despite not qualifying for them, according to federal and state eligibility requirements, they may be committing disability fraud. To report someone for disability fraud, you'll want to document what they're doing that's illegal, when they're doing it, how they're doing it, and who else knows about it. When collecting this evidence, make sure to follow both federal and state laws, or you could risk being sued. Once you've gathered sufficient evidence, report it to the federal Social Security Administration through their online form or by phone, mail, or fax. If you live in a state that offers state disability insurance benefits, you may need to report to them, as well. After submitting your evidence, you may be contacted by a federal or state agency to answer follow-up questions. For more tips from our Law co-author, including how to recognize disability fraud, keep reading.
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