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Social Security disability payments provide a lifeline for many Americans. But as with any benefits program, some recipients take advantage and seek payments under false premises, adding waste to the system and siphoning off funds that could be used to benefit others. To report disability fraud, you should first understand how federal disability programs operate.
How Do Federal Disability Programs Work?
There are two types of disability insurance provided through the Social Security Administration:
- Social Security Disability Insurance (SSDI) provides crucial income support to Americans who suffer from injuries or illnesses that prevent them from being able to work over long periods of time.
- Supplemental Security Insurance (SSI) provides aid to low-income disabled persons, whether or not they've ever worked.
Fraud for either program is investigated by the SSA's Office of Inspector General (OIG).
What Is Disability Fraud?
Disability fraud is a crime in which someone collects disability benefit payments they're not entitled to. It can take several forms, including:
- Misrepresenting or falsifying a diagnosis or symptoms on an application for disability benefits so as to improperly claim eligibility for disability payments.
- Accepting benefits while also receiving unreported payments through workers' compensation or a private long-term disability insurance program.
- Continuing to accept disability benefit payments after recovering from an illness or an injury that made working impossible.
- Under certain circumstances, working at one or more paying jobs while collecting disability payments.
Note that SSDI recipients may legitimately work at jobs that pay less than their monthly SSDI benefit amount, as long as they report their income to the SSA. (Their benefit payments are then reduced by the amount they earn each month.) Some SSDI beneficiaries may also be allowed to stay in the program while working full time on a trial basis so as to determine whether or not they can handle the demands of a new job.
Recipients of disability benefits aren't the only ones who can commit disability fraud. When caretakers are entrusted to manage the needs of a person with disabilities (PWD), the caretakers also may abuse the system, in instances such as the following:
- Use of SSDI or SSI benefits by a caretaker (the parent or guardian of a person with a qualifying disability) for purposes other than meeting the needs of the person with the disability.
Note that caretakers who live with beneficiaries may legitimately use SSDI funds for certain home repairs, the purchase and maintenance of vehicles used to transport the PWD, and other expenses that indirectly benefit the person under their care.
- Accepting and cashing disability payment checks after the PWD has died.
Who Is Eligible for Disability Benefits—and Who Is Not?
SSDI is available to any American over the age of 18 who suffers from a medical condition that is expected to keep them from working for a period of one year or longer, or that is expected to lead to their death. SSDI is provided by the federal government through the Social Security Administration.
SSDI coverage is intended to last until the beneficiary recovers from his or her illness or injury, but many beneficiaries suffer from chronic or incurable conditions and only exit the SSDI rolls when they die. The SSDI application process includes extensive vetting, and requires documentation of medical diagnoses.
SSI is available to disabled persons of any age who document that they have less than $2,000 in assets, and that their income is nonexistent or insufficient (a measure that varies according to local living standards).
Disabilities covered under SSDI and SSI encompass a wide range of conditions and symptoms.
In the case of SSDI, they include injuries that impair workers' ability to do physical labor such as heavy lifting or standing for extended periods, and also extends to many less visible conditions: Impairment of hearing, vision or ability to concentrate, for instance, can arise from a variety of physical and mental illnesses, as side effects of medications, or as a consequence of brain injuries, tumors or strokes.
What constitutes a disabling condition under SSDI also depends to some extent on the nature of the work the affected person did when the condition arose. For instance, someone with a desk job might be able to continue working despite impaired leg mobility by means of a wheelchair or other accommodations. But the same impairment might prevent a chef or firefighter from doing their job.
It's not uncommon for someone to suffer both physical and "invisible" injuries in a single incident, such as a car accident or workplace mishap, and for mental or sensory impairments to persist after bodily injuries heal.
What to Do If You Suspect Abuse of the Disability System
If you believe you know of a case of disability fraud, you can report it online to the Social Security Administration (SSA) Office of Inspector General (OIG) or by calling the OIG at 1-800-269-0271.
The OIG looks into all reports, but gives priority to those that back up charges with evidence. Any of the following information may improve the likelihood of a successful investigation:
- Name, address, date of birth and Social Security number (if available) of the person suspected of fraud.
- Paperwork that contradicts the medical basis for a disability claim or that demonstrates misuse of SSDI or SSI benefit payments. (These could include endorsed checks, medical reports, evidence of unpaid medical expenses and so on.)
- Photographic or video documentation of the suspected fraudster engaging in activity that would be precluded by their claimed disability. (An extreme example: a video of someone claiming legal blindness as a qualifying disability driving a car.)
When attempting to document disability fraud, make sure you do it legally. Don't trespass while using your camera or collecting paperwork, and if you want to record a phone conversation without the other person's knowledge, make sure doing so is legal in your state.
When you report disability fraud, the OIG gives you several confidentiality options:
- Remain anonymous. You submit your report without identifying yourself in any way. This keeps you out of the fraud inquiries, but may make it difficult for OIG investigators to obtain relevant follow-up information.
- Keep the report confidential. You identify yourself and tell the OIG how to reach you for follow-up on the investigation, but the OIG doesn't make your complaint public. Depending on the evidence you provide, the OIG may be legally required to disclose your identity to specific legal authorities if criminal fraud charges are pursued.
- Waive confidentiality. Your name is on the record as part of the complaint, and the OIG can freely share your contact information with other authorities.
What if Your Suspicion Is Wrong?
Deliberately misreporting abuse of the SSDI or SSI programs is against the law, but if you make a good-faith report of suspected abuse and the OIG finds it unfounded, there will be no repercussions to you. Note, however, that unfounded abuse allegations needlessly consume investigators' time and resources, and can cause considerable stress for the person with a disability who is placed under investigation.