Is Social Security Fraud Keeping You from Getting Benefits?

Social Security fraud

The SSA’s disability benefits program is often accused of being a hotbed for Social Security fraud. News outlets have even run stories aimed at catching fraudsters in the act, throwing phrases around such as, “extra cash” and “milking the system.” But are they right? Is the program designed to help those in need really overrun by con artists intent on pulling a fast one?

The answer isn’t simple, and opinions on the subject will vary depending on who you ask. In this article we’ll dig into the facts and uncover if Social Security fraud is as rampant as people claim.

What Is Social Security Fraud?

This questions may seem obvious, but in the world of Social Security, the definition of “fraud” isn’t one size fits all. In fact, some people may not even realize they are committing acts that would be deemed as fraud or misuse. According to the Office of the Inspector General (OIG), here are a few examples of what may constitute Social Security fraud:

  • Making false statements on claims
  • Concealing facts or events that affect eligibility
  • Misusing benefits as a representative payee
  • Buying or selling counterfeit or legitimate Social Security cards
  • Social Security Number (SSN) misuse involving terrorist groups or activity
  • Crimes involving Social Security Administration employees
  • Scams involving the impersonation of a Social Security Administration employee
  • Bribery of a Social Security Administration employee
  • Fraud or misuse of a grant or contracting funds
  • Standards of conduct violations by a Social Security Administration employee
  • Workers’ compensation fraud

As you can see, Social Security fraud can affect more than just beneficiaries. Even Social Security Administration (SSA) employees may be subject to an investigation if accusations of fraud are present. When applying for benefits the SSA requires you to be truthful about your condition and the limitations that you have. Failure to do so could result in a criminal investigation or termination of benefits. By the same token, they are also trusting that SSA employees abide by the program’s code of conduct.

How is Social Security Fraud Recorded?

Twice a year, the Office of Inspector General (OIG) releases a semiannual report to Congress. This report sheds light on the department’s recovery efforts and are released as Spring (October – March) and Fall (April -September) editions—accounting for the fiscal year. If you’d like to check out the report yourself, you can find a summary on the OIG’s website. Within these reports we get a better understanding of how fraud is spread out amongst the program and the recovery efforts that have been made. In addition, tracking these statistics maintains the integrity of the program by weeding out individuals who are abusing funds. The OIG encompasses the following programs when reporting allegations of fraud:

  • Social Security disability insurance (SSDI) benefits
  • Supplemental Security Income (SSI) benefits for lowest-income disabled and aged Americans
  • Social Security number (SSN) misuse
  • Old-age survivors insurance
  • Threats/employee safety
  • Employee-related theft

In the fiscal year of 2015, there were a total of 146,525 allegations received by the department. These allegations were distributed amongst the categories above, with disability insurance fraud accounting for 61,168 allegations.

The 2015 Fiscal Year Investigative Results Into Social Security Fraud

Now that we have distinguished exactly what an allegation of fraud is, let’s take a closer look at the OIG’s investigative results for 2015. Below, we’ve mapped out exactly how many allegations were received, how many cases were opened, closed, and any penalties accused fraudsters received.

  • Allegations received: 146,525
  • Cases opened: 8,419
  • Cases closed: 8,182
    • Arrests: 454
    • Indictments/informations: 936
    • Criminal convictions: 1,243
    • Civil Action/CPMS: 336
  • Projected SSA savings: $270.4 million

What Does The Social Security Fraud Data Actually Mean?

In 2015, there were approximately 146,525 allegations of Social Security fraud. However, the OIG only opened 8,419 cases for investigation. This means that only 5.75% of allegations warranted further investigation by the OIG. While there’s no indication within the data as to why so few investigations were opened, it is possible that not enough evidence was submitted by the accuser in order to start a case. Such low numbers could also steam from the bandwidth within the OIG. If the number of active investigators in the OIG are low, they may only be able to open cases of higher priority. Either way, theses numbers are striking and may reveal further issues within the program.

On the flip side, the data shows us that out of 8,182 closed cases, 2,969 resulted in an arrest, indictments/informations, criminal convictions, or civil action/CPMS. This means that over 36% of claims that were closed resulted in some type of prosecution. While these numbers do not represent the majority of closed cases, it does show that the OIG is taking action against criminals who are trying to scam Social Security programs.

The SSA investigations were tackled by an OIG and SSA initiative know as the Cooperative Disability Investigations (CDI). The efforts put forth by the CDI resulted in $270.4 million in projected savings by the SSA. These savings are a huge accomplishment and can now be put to better use or potentially help those who are in actual need.

Our Take on Social Security Fraud

So, is Social Security fraud really that bad within the SSA? The numbers don’t indicate that it is. Let’s put it this way: In 2015 there were about 60 million people who collected benefits from the Social Security program. Out of all these there were only 146,525 allegations of fraud received by the OIG. To put it into perspective that’s only .01% of active claims that sparked any notion of suspicious activity. This small number speaks volumes and may indicate that while there are bad seeds within the program, it does not represent the majority of people who are applying or who are actually drawing monthly benefits.

Remember: these numbers only reflect the accused, which means that there is reason to believe that some cases of fraud may be under the radar. If you suspect fraud, don’t be afraid to report it. The OIG and SSA encourage citizens to speak up and not ignore warning signs. You can use the SSA’s website to report suspected cases of fraud, misuse, and abuse. These reports can be submitted anonymously by private citizens or a business. For an extra sense of security you have the option to keep your report confidential. This is great for people who may be hesitant to file or may feel uneasy about submitting personal information in a fraud case.

You May Qualify for Legal Assistance

When applying for benefits it’s crucial to be honest on your application. Exaggeration or suspicious documentation can raise red flags with Disability Determination Services (DDS). This is one way people accidentally get their cases flagged for allegations of Social Security fraud. If you’re unsure about how to apply or feel as though your medical evidence isn’t substantial, you should consider hiring a disability advocate or attorney. Both advocates and attorneys know the ins and outs of the program and can help you not only file your initial application, but also help you retrieve needed medical records that best support your claim.

Ready to see if you may qualify? Click the button below to start your free benefits evaluation now.

Get Your Free Benefits Evaluation