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DI 33025.035: Criminal Violations - Suspected Fraud

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  • Effective Dates: 02/22/2013 - Present
  • Effective Dates: 12/13/2017 - Present
  • TN 4 (02-90)
  • TN 10 (12-17)
  • DI 33025.035 Criminal Violations - Suspected Fraud
  • A. Background
  • A. Background on fraud or similar fault (FSF) violations
  • See DI 23025.000.
  • The disability hearing unit (DHU) may receive a case that is under investigation for FSF, or a case with a completed investigation. Rarely, will the DHU be the first to identify a potential FSF issue. The DHU may make an FSF referral; see the FSF referral policy and procedures in DI 23025.015 Disability Determination Services (DDS) – Referring Potential Fraud or Similar Fault (FSF) Cases for Possible Prosecution.
  • B. Policy
  • B. Policy - Handling a case identified as a ‘Potential Violation’
  • The Federal Statute of Limitations set forth at 18 U.S.C. 3282, as here applicable, prevents prosecution of an individual unless indicted, or unless criminal information is instituted, within five years of the date the alleged violation was committed except as otherwise expressly provided by law. (See C.b below if this becomes relevant to the case.)
  • The Federal statute of limitations set forth in 18 U.S.C. 3282, as here applicable, “prevents prosecution of an individual, tried, or punished for any offense, not capital, unless the indictment is found or the information is instituted within five years next after such offense shall have been committed.” (If this becomes relevant to the case, see DI 33025.035C.1 in this section).
  • The disability hearing is not the forum for criminal prosecution. Accordingly, the DHU will not investigate, query, or be influenced in a decision by the fact that a case has been identified as a “potential violation” case and is under investigation.
  • The disability hearing is not the forum for criminal prosecution. Therefore, the DHU will not investigate, query or be influenced in a decision by the fact that the case is identified as a “potential violation” case and is under investigation. The DHU will resolve ordinary issues as usual.
  • C. Procedure
  • * Handle a case the DHU identifies as one requiring investigation of a potential violation or attempt to defraud an SSA program per DI 23025.020.
  • * Telephone the contact shown in DI 23025.020 for advice, and note the contact in the DHU and claims folders if the statute in B above is relevant.
  • C. Procedure - Handling Potential FSF Cases by the DHU
  • If the DHU identifies a case requiring additional investigation, follow the steps below:
  • * When processing a DHU case that has had an FSF referral, follow the guidance in DI 23015.020 Disability Determination Services (DDS) - Procedures after the Fraud or Similar Fault (FSF) Referral is Sent.
  • * When the DHU identifies a case requiring investigation of a potential violation or attempt to defraud a Social Security Administration (SSA) program, handle it per DI 23025.020 Disability Determination Services (DDS) – Procedures after the Fraud or Similar Fault (FSF) Referral is Sent.
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