[Federal Register Volume 87, Number 95 (Tuesday, May 17, 2022)]
[Notices]
[Pages 29993-29995]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-10559]
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SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2020-0018]
Social Security Ruling 22-2p; Titles II and XVI: Evaluation of
Claims Involving the Issue of Similar Fault in the Providing of
Evidence
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling (SSR).
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SUMMARY: We are providing notice of SSR 22-2p. This ruling rescinds and
replaces SSR 16-2p and explains when we may find that there is a reason
to believe that similar fault was involved in the providing of evidence
to us in support of a claim under titles II or XVI of the Social
Security Act (Act). We are revising the evidentiary standard for
similar fault from a ``preponderance of the evidence'' to ``reason to
believe'' to align more closely with the standard provided in the Act.
We are also incorporating into this ruling a procedure that we
currently have in other subregulatory instructions. The procedure
provides that, before we disregard evidence under the Act at the
hearings level of our administrative review process, we will consider
the individual's objection to the disregarding of that evidence. We
expect that the procedures we follow under this ruling will allow us to
implement relevant sections of the Act in a manner consistent with the
Act and principles of constitutional due process.
DATES: We will apply this notice on May 17, 2022.
FOR FURTHER INFORMATION CONTACT: Mary Quatroche, Office of Disability
Policy, Social Security Administration, 6401 Security Boulevard,
Baltimore, MD 21235-6401, 410-597-1632. For information on eligibility
or filing for benefits, call our national toll-free number 1-800-772-
1213 or visit our internet site, Social Security online, at http://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do
not require us to publish this SSR, we are publishing it in accordance
with 20 CFR 402.35(b)(1). SSRs do not have the same force and effect as
statutes or regulations, but they are binding on all components of the
Social Security Administration. 20 CFR 402.35(b)(1).
We use SSRs to make available 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 in our administrative review
process, Federal court decisions, decisions of our Commissioner,
opinions from our Office of the General Counsel, or other
interpretations of law and regulations.
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--Supplementary Security Income.)
The Acting Commissioner of Social Security, Kilolo Kijakazi,
having reviewed and approved this document, is delegating the
authority to electronically sign this document to Faye I. Lipsky,
who is the primary Federal Register Liaison for the
[[Page 29994]]
Social Security Administration, for purposes of publication in the
Federal Register.
Faye I. Lipsky,
Federal Register Liaison, Office of Legislation and Congressional
Affairs, Social Security Administration.
Policy Interpretation Ruling
SSR 22-2p: Titles II and XVI: Evaluation of Claims Involving the Issue
of Similar Fault in the Providing of Evidence
This Social Security Ruling (SSR) rescinds and replaces SSR 16-2p:
``Titles II and XVI: Evaluation of Claims Involving the Issue of
Similar Fault in the Providing of Evidence.''
Purpose: To explain the process we use when we evaluate and
adjudicate claims in which there is reason to believe similar fault was
involved in the providing of evidence to us in support of a claim for
benefits under title II or payments under title XVI of the Social
Security Act (Act).
Citations (Authority): Sections 205(u) and 1631(e)(7) of the Social
Security Act, 42 U.S.C. 405(u) and 1383(e)(7), as amended; 20 CFR
404.704, 404.708, 404.1512, 404.1520, 416.912, 416.920, 416.924, and
422.130.
Dates: We will apply this notice on May 17, 2022.
Introduction
The Social Security Independence and Program Improvements Act of
1994, Public Law 103-296, amended the Act to add provisions addressing
fraud or similar fault. These amendments to sections 205 and 1631 of
the Act require us to immediately redetermine an individual's
entitlement to monthly insurance benefits under title II or eligibility
for payments under title XVI if there is reason to believe that fraud
or similar fault was involved in the individual's application for such
benefits or payments.
The Act 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.'' \1\
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\1\ See 42 U.S.C. 405(u)(1)(B) and 1383(e)(7)(A)(ii).
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This ruling explains the standards we use when we determine whether
there is reason to believe that similar fault was involved in providing
evidence in connection with a claim for benefits or payments. The
ruling applies to all claims for benefits under title II or payments
under 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 payments 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 in accordance
with our rules. There may be instances in which we will not disregard
evidence under the statutory provisions discussed in this ruling, but
nevertheless, factors may exist that justify considering the evidence
in question less persuasive or probative than other evidence.
Policy Interpretation
A. General
1. Sections 205(u) and 1631(e)(7) of the Act require us to
disregard evidence if there is reason to believe that fraud or similar
fault was involved in the providing of that evidence.
2. A finding that there is reason to believe similar fault was
involved in providing evidence 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.
3. We may discover suspected fraud or similar fault related to a
claim for benefits or payments or in the provision of evidence in a
variety of ways. Most often, we learn about fraud from our Office of
the Inspector General (OIG). OIG is responsible for investigating fraud
in our programs and must notify us under section 1129(l) of the Act
when it has reason to believe that fraud was involved in an
individual's claim for benefits or payments, including in the provision
of evidence. We refer to this notification as a section 1129(l)
referral. We may also learn about fraud from a Federal or State
prosecutor during the course of a criminal investigation or
prosecution. With regard to similar fault, as we administer our
programs, we may uncover information that provides a reason to believe
similar fault was involved in the provision of evidence in an
individual's claim for benefits or payments.
4. We may find there is reason to believe similar fault was
involved in providing evidence based on the actions of any individual
whose actions affect the evidence provided in support of the claim,
even when such an individual has no direct relationship to the
claimant, beneficiary, or recipient or acts without the claimant,
beneficiary, or recipient's knowledge or participation. These
individuals may include, but are not limited to, claimants,
beneficiaries, auxiliaries, recipients, spouses, representatives,
medical sources, translators, interpreters, and representative payees.
For example, we may have reason to believe a medical source or
representative provided false information to support a claim without
the knowledge or participation of the claimant, beneficiary, or
recipient.
5. We must disregard evidence under sections 205(u)(1)(B) and
1631(e)(7)(A)(ii) of the Act due to similar fault if there is reason to
believe, meaning reasonable grounds to suspect, that the person knew
the evidence provided was false or incomplete or that the information
that was material to the determination was knowingly concealed. A
finding of similar fault requires more than mere suspicion,
speculation, or a hunch, but it does not require a preponderance of
evidence.
6. In certain circumstances, we may disregard evidence provided by
someone who has not committed fraud or similar fault, but whose
evidence relies on other evidence involving fraud or similar fault. For
example, we may disregard parts of a medical source's opinion which
rely on evidence that we disregarded from another medical source.
Depending on the extent to which the medical source relied on the
disregarded evidence, we may disregard some or all of the medical
source's opinion.
7. Before we disregard evidence pursuant to sections 205(u)(1)(B)
and 1631(e)(7)(A)(ii) of the Act at the hearings level of our
administrative review process, we will consider the individual's
objection to the disregarding of that evidence. After considering any
objections, our adjudicators will decide whether there is reason to
believe that similar fault was involved in providing evidence in the
individual's case.
8. Generally, a finding that there is reason to believe similar
fault was involved in providing evidence does not constitute complete
adjudicative action in any claim. Even if we disregard evidence, we
will evaluate the remaining evidence of record and determine whether
that evidence supports a finding of entitlement to benefits or
eligibility for payments.
9. If, after disregarding evidence, we determine an individual is
not entitled to benefits or eligible for payments, an individual who is
dissatisfied with our determination or decision may request an appeal
of our determination or decision. In conjunction with such an appeal,
an individual may object to our finding to disregard evidence under the
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Act. We will consider any appeal in accordance with our rules for
administrative review.
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 Act; or conceals or fails to disclose a material fact for use
in determining rights under the Act.
2. Similar Fault. Similar fault is involved with respect to a
determination if: ``an incorrect or incomplete statement that is
material to the determination is knowingly made or information that is
material to the determination is knowingly concealed.'' \2\
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\2\ See 42 U.S.C. 405(u)(2) and 1383(e)(7)(B).
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3. Material. Material 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. Knowingly 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. Reason to Believe. Reason to believe means reasonable grounds to
suspect that fraud or similar fault was involved in the application or
the provision of evidence. The reason to believe standard requires more
than mere suspicion, speculation, or a hunch, but it does not require a
preponderance of evidence.
C. Development and Evaluation
1. 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. If we do
not find that there is reason to believe evidence provided by a source
involved similar fault, we will consider the evidence in accordance
with our rules such as our rules regarding evaluating symptoms and
medical evidence. We will adhere to existing due process and
confidentiality requirements during the process of resolving similar
fault issues.
2. In making a determination or decision about whether there is
similar fault, all adjudicators must:
a. Consider all evidence in the case record before determining
whether specific evidence must be disregarded.
b. Determine if there is a reason to believe, as defined in this
ruling, that similar fault was involved in the provision of evidence.
Adjudicators may make reasonable inferences based on all the
information in the record such as facts or case characteristics common
to patterns of known or suspected fraudulent activity. For us to
disregard evidence, it is not necessary that the affected beneficiary
or recipient had knowledge of or participated in the fraud or similar
fault.
c. Disregard the evidence and fully document the record with the
description of the disregarded evidence and the reasons for
disregarding the evidence, if the adjudicator determines that there is
a reason to believe similar fault was involved in the provision of the
evidence.
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 a
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. A similar fault finding can be made
only if there is reason to believe 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 benefits or
eligible for payments despite 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.
Cross-References: SSR 85-23: Title XVI: Reopening Supplemental
Security Income Determinations at Any Time for ``Similar Fault''; SSR
22-1p: Titles II and XVI: Fraud and Similar Fault Redeterminations
Under Sections 205(u) and 1631(e)(7) of the Social Security Act.
[FR Doc. 2022-10559 Filed 5-16-22; 8:45 am]
BILLING CODE 4191-02-P