[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]


=======================================================================
-----------------------------------------------------------------------

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).

-----------------------------------------------------------------------

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\
---------------------------------------------------------------------------

    \1\ See 42 U.S.C. 405(u)(1)(B) and 1383(e)(7)(A)(ii).
---------------------------------------------------------------------------

    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

[[Page 29995]]

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\
---------------------------------------------------------------------------

    \2\ See 42 U.S.C. 405(u)(2) and 1383(e)(7)(B).
---------------------------------------------------------------------------

    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