81 FR 13439 - Social Security Ruling, SSR 16-2p; Titles II and XVI: Evaluation of Claims Involving Similar Fault in the Providing of Evidence

SOCIAL SECURITY ADMINISTRATION

Federal Register Volume 81, Issue 49 (March 14, 2016)

In accordance with 20 CFR 402.35(b)(1), the Commissioner of Social Security gives notice of SSR 16-2p. This Ruling supersedes and replaces previously published SSR 00-2p. It provides the definition of fraud, and clarifies the definitions of knowingly and preponderance of the evidence. The Ruling also clarifies that we may find that any individual or entity has committed fraud or similar fault, and that we may disregard evidence submitted by any individual or entity that we find has committed fraud or similar fault. In addition, the Ruling provides examples of such individuals and entities.

[Federal Register Volume 81, Number 49 (Monday, March 14, 2016)]
[Notices]
[Pages 13439-13441]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-05660]


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SOCIAL SECURITY ADMINISTRATION

[Docket No. SSA-2015-0038]


Social Security Ruling, SSR 16-2p; Titles II and XVI: Evaluation 
of Claims Involving Similar Fault in the Providing of Evidence

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling (SSR).

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SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of SSR 16-2p. This Ruling supersedes and 
replaces previously published SSR 00-2p. It provides the definition of 
fraud, and clarifies the definitions of knowingly and preponderance of 
the evidence. The Ruling also clarifies that we may find that any 
individual or entity has committed fraud or similar fault, and that we 
may disregard evidence submitted by any individual or entity that we 
find has committed fraud or similar fault. In addition, the Ruling 
provides examples of such individuals and entities.

DATES: Effective Date: March 14, 2016.

FOR FURTHER INFORMATION CONTACT: Dan O'Brien, Director of Office of 
Vocational Evaluation and Process Policy in the Office of Disability 
Policy, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 597-1632 or TTY 410-966-5609, for 
information about this notice. For information on eligibility or filing 
for benefits, call our national toll-free number, 1-800-772-1213 or TTY 
1-800-325-0778, or visit our Internet site, Social Security Online, at 
http://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION: Although we are not required to do so 
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this SSR 
in accordance with 20 CFR 402.35(b)(1).
    Through SSRs, we convey to the public precedential decisions 
relating to the Federal old-age, survivors, disability, supplemental 
security income, and special veterans benefits programs. We may base 
SSRs on determinations or decisions made at all levels of 
administrative adjudication, Federal court decisions, Commissioner's 
decisions, opinions of the Office of the General Counsel, or other 
interpretations of the law and regulations.
    Although SSRs do not have the same force and effect as statutes or 
regulations, they are binding on all components of the Social Security 
Administration, in accordance with 20 CFR 402.35(b)(1), and are binding 
as precedents in adjudicating cases.
    This SSR will remain in effect until we publish a notice in the 
Federal Register that rescinds it, or we publish a new SSR that 
replaces or modifies it.

(Catalog of Federal Domestic Assistance, Programs Nos. 96.001, 
Social Security--Disability Insurance; 96.002, Social Security--
Retirement Insurance; 96.004, Social Security--Survivors Insurance; 
96.006--Supplemental Security Income.)


[[Page 13440]]


    Dated: March 7, 2016.
Carolyn W. Colvin,
Acting Commissioner of Social Security.

POLICY INTERPRETATION RULING

Social Security Ruling, SSR 16-2p:
TITLES II AND XVI: EVALUATION OF CLAIMS INVOLVING THE ISSUE OF SIMILAR 
FAULT IN THE PROVIDING OF EVIDENCE
    This SSR rescinds and replaces SSR 00-2p: ``TITLES II AND XVI: 
EVALUATION OF CLAIMS INVOLVING THE ISSUE OF ``SIMILAR FAULT'' IN THE 
PROVIDING OF EVIDENCE.''
    PURPOSE: To explain the rules that govern the evaluation and 
adjudication of claims when there is reason to believe similar fault 
was involved in the providing of evidence in support of the claim.
    CITATIONS: Sections 205(u) and 1631(e)(7) of the Social Security 
Act, 42 U.S.C. 405(u), 1383(e)(7), as amended; 20 CFR 404.704, 404.708, 
404.1512, 404.1520, 416.912, 416.920, 416.924, and 422.130(b).

INTRODUCTION:

    The Social Security Independence and Program Improvements Act of 
1994, Public Law 103-296, amended the Social Security Act (Act) to add 
provisions addressing fraud or similar fault. These amendments to 
sections 205 and 1631 of the Act provide that we must immediately 
redetermine an individual's entitlement to monthly insurance benefits 
under title II or eligibility for benefits under title XVI if there is 
reason to believe that fraud or similar fault was involved in the 
individual's application for such benefits. This statute further 
provides that, when we redetermine entitlement or eligibility, or when 
we make an initial determination of entitlement or eligibility, we 
``shall disregard any evidence if there is reason to believe that fraud 
or similar fault was involved in the providing of such evidence.'' If, 
after redetermining entitlement to or eligibility for benefits, we 
determine that without the disregarded evidence, the evidence does not 
support entitlement or eligibility, we may terminate such entitlement 
or eligibility and may treat benefits paid based on such evidence as 
overpayments.
    This Ruling sets forth the standards we and State agency 
adjudicators will apply at all levels of the administrative review 
process in determining whether there is reason to believe that similar 
fault was involved in providing evidence in connection with a claim for 
benefits. It also provides guidance for the evaluation of such claims 
when there is reason to believe that similar fault was involved. It 
applies to all claims for benefits under title II and title XVI of the 
Act; e.g., claims for old-age and survivors benefits and disability 
benefits under title II of the Act, and claims for Supplemental 
Security Income benefits for the aged, blind, and disabled under title 
XVI of the Act.
    This Ruling does not replace or limit other appropriate standards 
and criteria for development and evaluation of claims. There may be 
instances in which evidence will not be disregarded under the statutory 
provisions discussed in this Ruling, but nevertheless, factors may 
exist that justify giving the evidence in question less credence than 
other evidence.

POLICY INTERPRETATION:

A. General

    1. Sections 205(u) and 1631(e)(7) of the Act provide that we must 
disregard evidence if there is reason to believe that fraud or similar 
fault was involved in the providing of that evidence. These sections 
explain that similar fault is involved if: ``(A) an incorrect or 
incomplete statement that is material to the determination is knowingly 
made; or (B) information that is material to the determination is 
knowingly concealed.''
    2. We may find that any individual or entity whose actions affect 
an individual's application for monthly benefits, has committed fraud 
or similar fault. We may disregard evidence based on similar fault of a 
claimant, a recipient of benefits, or any other individual or entity 
connected with the claim. Examples of any individual or entity include 
a claimant, beneficiary, auxiliary, recipient, spouse, representative, 
medical source, translator, interpreter, and representative payee. 
Sections 205(u) or 1631(e)(7) of the Act do not require that the 
individual or entity who committed fraud or similar fault, or the 
individual or entity providing the evidence that involves fraud or 
similar fault, have a direct relationship to or act on behalf of the 
claimant, beneficiary, or recipient, or directly or indirectly benefit 
from the fraud or similar fault.
    3. A finding of similar fault can be made only if there is reason 
to believe that, based on a preponderance of the evidence, the person 
committing the fault knew that the evidence provided was false or 
incomplete. We cannot base a finding of similar fault on speculation or 
suspicion.
    4. A finding of similar fault is sufficient to take the 
administrative actions described in this Ruling. Although a finding of 
``fraud'' made as part of a criminal prosecution can serve as a basis 
for the administrative actions described below, such a finding is not 
required.
    5. A finding of similar fault concerning a material fact may 
constitute evidence to be considered in determining whether there is 
reason to believe that similar fault was involved with respect to other 
evidence provided by the same source, and may justify disregarding 
other evidence from that source. Also, the evidence relied on to make a 
finding of similar fault in one claim may be considered in deciding 
whether there is similar fault in another claim or in deciding whether 
to give less weight to evidence in another claim.
    6. A finding of similar fault does not constitute complete 
adjudicative action in any claim. A person may still be found entitled 
to, or eligible for, monthly benefits despite the fact that some 
evidence in the case record has been disregarded based on similar 
fault.

B. Definitions

    1. Fraud. 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. As defined in section 205(u)(2) and 1631(e)(7)(B) 
of the Act, similar fault is involved with respect to a determination 
if: ``(A) an incorrect or incomplete statement that is material to the 
determination is knowingly made; or (B) information that is material to 
the determination is knowingly concealed.''
    3. Material. This term describes a statement or information, or an 
omission from a statement or information that could influence us in 
determining entitlement to benefits under title II or eligibility for 
benefits under title XVI of the Act.
    4. Knowingly. This term describes a person's awareness or 
understanding regarding the correctness or completeness of the 
information he or she provides us, or the materiality of the 
information he or she conceals from us.
    5. Preponderance of Evidence. This term means such relevant 
evidence that as a whole shows that the existence of a 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

[[Page 13441]]

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.

C. Development and Evaluation

    Adjudicators at all levels of the administrative review process are 
responsible for taking all appropriate steps to resolve similar fault 
issues in accordance with the standards in this Ruling. Adjudicators 
must adhere to existing due process and confidentiality requirements 
during the process of resolving similar fault issues.
    In making determinations about whether there is similar fault, all 
adjudicators must:
    1. Consider all evidence in the case record before determining 
whether specific evidence may be disregarded.
    2. Apply the preponderance of evidence standard, as defined in this 
Ruling.
    3. Fully document the record with the evidence that was the basis 
for the finding that, based on a preponderance of the evidence, there 
is reason to believe that similar fault was involved in providing the 
evidence that is being disregarded.

D. Notice of Determination or Decision

    In determinations or decisions that involve a finding of similar 
fault and disregarding evidence, the notice of determination or 
decision must:
    1. Explain the applicable provision of the Act that allows the 
adjudicator to disregard particular evidence due to a similar fault 
finding.
    2. Identify the documents or other evidence that is being 
disregarded.
    3. Provide a discussion of the evidence that supports a finding to 
disregard evidence. The discussion must explain that, in accordance 
with the law, the evidence identified cannot be used as evidence in the 
claim because, after considering all the information in the case 
record, the adjudicator has reason to believe that similar fault was 
involved in providing the evidence and it must be disregarded. Again, a 
similar fault finding can be made only if there is reason to believe, 
based on a preponderance of the evidence, the person knew that the 
evidence provided was false or incomplete. A similar fault finding 
cannot be based on speculation or suspicion.
    4. Provide a determination or decision based on an evaluation of 
the remaining evidence in accordance with other rules and procedures. A 
similar fault finding does not constitute complete adjudicative action 
in any claim. A person may still be found entitled to, or eligible for, 
monthly benefits despite the fact that some evidence in the case record 
has been disregarded based on similar fault. For example, a person may 
be found to be under a disability based on impairments that are 
established by evidence that is not disregarded because of similar 
fault.
    5. Include standard appeal language.
    EFFECTIVE DATE: This SSR is effective on March 14, 2016.
    CROSS-REFERENCES: SSR 85-23, ``Title XVI: Reopening Supplemental 
Security Income Determinations at Any Time for Similar Fault.''

[FR Doc. 2016-05660 Filed 3-11-16; 8:45 am]
 BILLING CODE 4191-02-P