TN 25 (04-14)

A. General background on OIG investigations

The OIG generally investigates fraud cases that meet the prosecutive acceptance guidelines for the federal judicial district where the fraud occurred. OIG has several other courses of action it can take in addition to seeking federal prosecution such as referring cases to State or local courts.

In addition, under the Social Security Protection Act of 2004, the Office of the Chief Counsel to the Inspector General may impose civil monetary penalties (CMP) against persons who make, or cause to make, false statements (including wrongful conversions by representative payees) or omissions of material facts to SSA. There is no required or suggested minimum dollar loss to refer an allegation for CMP consideration.

For cases the OIG does not open as a criminal investigation, SSA may impose administrative sanctions against the person.

B. How to determine if you should forward a case to OIG

Usually, OIG requires that a case not be more than 5 years old. However, depending on the specific case circumstances, OIG may pursue an investigation on a case older than 5 years. Follow the procedures below to determine whether to forward a case to OIG for investigation:

• contact your servicing OIG field office regarding your specific allegation; and

• refer the case to the OIG via the e8551 (Electronic Reporting Form for Programmatic Fraud). To obtain an electronic copy of the e8551, see e8551 - Reporting Form for Programmatic Fraud. You may call your servicing OIG office of guidance.

• if OIG does not wish to investigate, see DI 11006.030 for administrative sanctioning instructions.

If we are unable to implement sanctions, take steps to recover overpayment. For additional overpayment, recovery instructions see GN 02210.000 through GN 02210.230.

NOTE: OIG bases their determination on a combination of several factors including the dollar amount of the checks involved, and the case circumstances.

C. How to forward case to OIG to investigate

NOTE: In the event that the money is in the process of being refunded (repayment agreement), make note of that fact when forwarding the case to OIG. OIG may initiate a CMP action if deemed appropriate.

1. PC responsibility

To forward the case to OIG via the e8551, PC employees should follow instructions in GN 04111.025 How the Processing Center (PC) Reports Program Violations. To obtain an electronic copy of the e8551, see e8551 - Reporting Form for Programmatic Fraud.

2. FO responsibility

To forward the case to OIG via the e8551, FO employees should follow instructions in GN 04111.010 How the Field Office (FO) Reports Program Violations. To obtain an electronic copy of the e8551, see e8551 - Reporting Form for Programmatic Fraud.

3. PC and FO responsibility

Send a notice to the beneficiary or recipient in those cases where there will be a delay in the check replacement until after completion of OIG's investigation. For additional information, see NL 03001.030.

See details:

GN 04111.000 Reporting Program Violations

D. Procedure for OIG investigation, determination, and closure

While awaiting the outcome of OIG's investigation and to bring the case to closure, follow the instructions below.

1. Handling payment on record

If OIG decides to pursue an investigation, take no action on the record. Do not send out an overpayment notice. If OIG does not pursue investigation and a repayment agreement was proposed, accepted or filed during this time, proceed with collection. If no repayment agreement was proposed, see DI 11006.030 for administrative sanction instructions. If we are unable to implement sanctions take steps to recover the overpayment. For overpayment recovery instructions, see GN 02210.000 through GN 02210.230.

2. OIG does not investigate

If OIG accepts the case but subsequently decides that the case does not merit an investigation, they will provide SSA with a written explanation of their decision not to pursue. For additional information, see GN 04123.005B Disposition of Potential Violations by Office of Investigations Field Offices (OIFO).

When this situation occurs, and the individual has not proposed a repayment agreement see DI 11006.030 for administrative sanction instructions. If we are unable to implement sanctions take steps to recover the overpayment. For overpayment recovery instructions, see GN 02210.000 through GN 02210.230 However, if a repayment agreement was proposed, accepted, or filed during this time, revisit the repayment agreement documents and proceed with collection.

3. Written determination of the outcome

After OIG investigates and resolves the fraud aspects of the case, OIFO returns a written determination of the outcome, along with any case file, to SSA. For more information see GN 04123.005B.4.

If SSA recovers any funds, credit the recovered funds.