Last Update: 6/27/05 (Transmittal I-1-54)
Individual employees in any Office of Hearings and Appeals (OHA) component, including OHA Headquarters, may observe or discover possible criminal violations of the Social Security Act or other federal statutes. Any employee who believes that a criminal violation has occurred must report it and refer the violation to the Office of the Inspector General (OIG) by completing and submitting the electronic version of the Form SSA-8551-U4 (e8551). Instructions for completing this form can be found in POMS GN 04111.065.
NOTE:
The use of the e8551 is designated for program fraud only.
Allegations of employee misconduct should be referred by the following means:
calling the OIG Hotline at 1-800-269-0271 (10:00 a.m.- 4:00 p.m. EST);
sending a fax to 410-597-0118;
using the OIG Public Fraud Reporting Form at: www.socialsecurity.gov/oig/public_fraud_reporting/index.htm. (when using the form, select the following from “Select a SSA program or Violation” - “SSA Employee Fraud or Misconduct”);
mailing a report to:
OIG Hotlineor
using the OIG Hotline website.
Referrals may be anonymous or an employee may request the OIG maintain their identity as confidential.
If not referred to the OIG in accordance with A. above, suspected violations by employees will be referred as set forth below. If the alleged or suspected violation involves an employee in the routing process, the referral must be sent directly to the next level above that employee.
To the extent possible, the referring office should provide a description of the circumstances which constitute the basis for suspecting a violation. The referral should also include copies of substantiating documentation and evidence, including copies of pertinent portions of the files, statements of claimants, statements or admissions from the suspected offender, statements of witnesses, copies of any contracts or agreements between the parties, and other documentary evidence such as bills, receipts, canceled checks or money orders.
An employee in the District of Columbia Hearing Office (HO) or OHA Headquarters must report a suspected violation to an immediate supervisor, who will refer the matter to the Office of Management (OM).
The OM address, telephone number, fax number and e-mail address are:
Director, Office of ManagementOM will report the allegations of suspected employee violations to the Associate Commissioner, who will in turn contact the Office of Disability and Income Security Programs (ODISP) Executive Officer. After evaluating the situation and discussing it with the Deputy Commissioner for ODISP or his designee, ODISP will forward the information to OIG as deemed appropriate.
An employee in an HO or Regional Office (RO) must report a suspected violation to an immediate supervisor. In the HO, the supervisor will route the report to the Hearing Office Director (HOD), who will forward the report to the Regional Chief Administrative Law Judge (RCALJ) with all available evidence and documentation supporting the suspected violation. In the RO, the employee must report a suspected violation directly to the RCALJ
The RCALJ must forward the report and supporting documentation directly to the Associate Commissioner, who in turn will contact ODISP's Executive Officer. After evaluating the situation and discussing it with the Deputy Commissioner for ODISP or his designee, ODISP will forward the information as deemed appropriate to the appropriate Office of Investigations Field Division as soon as practicable (see I-1-3-90 for list of OIG Field Divisions).
Refer suspected violations by representatives as set forth below. (See also I-1-1-50 - Processing an Alleged Violation)
An employee in an HO must report a suspected violation to an immediate supervisor. In the HO, the supervisor will route the report to the HOD, who after fully developing the suspected violation as described below, will forward the report to the Office of the General Counsel's Office of General Law (OGL).
An employee in the RO must report a suspected violation to the RMO. After fully developing the suspected violation, as described below, the RMO will forward it to OGL.
An employee in OHA Headquarters must report a suspected violation to the supervisor. After fully developing the suspected violation, as described below, the report will be forwarded to the OGL.
To the extent possible, the referring office will provide a description of the circumstances which constitute the basis for suspecting a violation. The referral should also include copies of substantiating documentation and evidence, including copies of pertinent portions of the files, statements of claimants, statements or admissions from the suspected offender, statements of witnesses, copies of any contracts or agreements between the parties, and other documentary evidence such as bills, receipts, canceled checks or money orders.
The referring office will also indicate whether there are other questionable cases involving the same individual.
With regard to representative fee-related violations, development should include but is not limited to copies of forms such as the: SSA-1696-U4 (Appointment of Representative); Form SSA-1178 (Evaluation of Fee Petition for Representation; SSA-1560A-U5 (Authorization to Charge and Collect a Fee); SSA-1560-U4 (Petition to Obtain Approval of a Fee for Representing a Claimant Before the Social Security Administration); and HA-515-U6 or HA-515-U7 (fee agreement approval/disapproval orders). Copies of the fee agreement(s) should also be included for review particularly if it is alleged that language used in the fee agreement relates to the representative's misconduct. Also include copies of any correspondence by the claimant, auxiliary beneficiaries and/or the representative that relate to status of the representative fees and/or representation (e.g., waiver of direct payment, waiver of fee, withdrawal of representative, claimant's discharge of representative). Include documentation related to multiple representatives if such is needed to clarify the status of the fee to a particular representative.
Forward the report with supporting evidence to OGL at the following address:
Office of the General CounselIf not referred to OIG by submitting an e-8551 in accordance with I-1-3-3 A. above, refer suspected claimant violations using the routing procedures described in I-1-3-3.B.1.
To the extent possible, the referring office will provide a description of the circumstances which constitute the basis for suspecting a violation. The referral should also include copies of substantiating documentation and evidence, including copies of pertinent portions of the files, statements of claimants, statements or admissions from the suspected offender, statements of witnesses, copies of any contracts or agreements between the parties, and other documentary evidence such as bills, receipts, canceled checks or money orders.
The referring office will furnish a copy of the audio recording and/or certified transcript of the hearing if one was held.
When a request for hearing is pending before an Administrative Law Judge (ALJ) and a U.S. Attorney or other law enforcement official requests that the matter be delayed because of a possible criminal violation, the ALJ will continue routine processing of the case and refer the request to the RCALJ for advice. The RCALJ must consult with the Office of the Chief Administrative Law Judge (OCALJ) and advise the ALJ accordingly. OCALJ should consult with the Office of the General Counsel before deciding how the RCALJ should respond to the request. Neither the ALJ nor the hearing office staff may undertake action on the suspected violation unless otherwise directed.
The ALJ must limit the hearing to the issues set forth in the notice of hearing and avoid initiating inquiries regarding suspected criminal violations which are not relevant to the merits of the case. This does not preclude the ALJ from resolving conflicts or discrepancies in the evidence, or from obtaining information essential to the proper disposition of the claim.
NOTE:
If during the course of the hearing the claimant or another witness offers testimony indicative of a violation of criminal law, do not attempt to obtain further information regarding the possible criminal conduct. For example, information regarding drug dealing which is unrelated to the pending claim may be disclosed at the hearing. Unauthorized disclosure of information obtained during a hearing could constitute a violation of the Privacy Act or the Social Security Act. If the claimant or another witness offers testimony indicative of a violation of criminal law, the ALJ must consult with the RCALJ regarding possible actions, if any, warranted by the testimony. The RCALJ must consult with the OCALJ and advise the ALJ accordingly. OCALJ should consult with the Office of the General Counsel before deciding how the RCALJ should proceed.
The ALJ must limit the decision to the issues set forth in the notice of hearing and not include any reference to suspected criminal violations. The ALJ should deal with false testimony or fraudulent documentation in terms of credibility, reliability and authenticity of the evidence rather than possible violations of the law, and issue a decision on the claim accordingly.
NOTE:
Documents or evidence of a false claim or any other suspected fraudulent or criminal activity should be reported to the RCALJ as set forth in I-1-3-3 B.1.