TN 35 (09-12)

CITATIONS: Section 222 of the Social Security Act

A. Background on processing fraud cases during the trial work period (TWP)

When a federal court convicts a beneficiary of fraud that involves concealment of work activity, he or she is not eligible to receive payments for any TWP months performed in or after March 2004, and before the date of conviction.

NOTE: The beneficiary is still entitled to a TWP even though he or she is not eligible for payment of benefits during the TWP months covered by the conviction court order.

B. Jurisdiction of fraud cases

Once the court convicts the beneficiary, forward all TWP fraud cases to the Center for Security and Integrity (OCO CSI) unit for effectuation. If you receive a TWP fraud case in the FO, immediately Fed Ex the paper folder to:

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C. Determining non-payable TWP months

When convicted of fraud, the beneficiary may not be eligible for payment for certain service months of the TWP. When considering nonpayment TWP months:

• The beneficiary is still entitled to a TWP even though he or she is not eligible for payment of benefits during the TWP months covered by the conviction court order. We continue to pay all auxiliaries on the account when the beneficiary is suspended, but we do not readjust benefits for a family maximum for TWP fraud suspension.

• The beneficiary is liable for repayment if we paid him or her for TWP months that we should not have. The amount of the overpayment is subject to appeal but is not subject to waiver rights.

NOTE: These procedures may occur in conjunction with or in addition to the administrative sanctions. For more information on administrative sanction procedures, see DI 11006.030.

D. How to input TWP fraud months

OCO CSI uses the disability control file (DCF) to record and effectuate the suspension of TWP fraud months. This process eliminates the need for a post-entitlement system (POS) input. The DCF initiates a T2 Redesign input that results in the suspension of disability benefits, and updates the master beneficiary record (MBR) for the TWP months that are not payable based on the fraud conviction. For more information on how TWP fraud months are posted to the MBR, see SM 00510.213 and SM 03005.285.

Since the DCF generates a suspension action:

• The field office (FO) or processing center (PC) should never initiate or change the DCF verified (VRFD) “F” coding for a TWP fraud determination.

• OCO CSI inputs all DCF suspension or reinstatement coding for TWP fraud cases.

• The FO or PC may process subsequent work actions on a TWP fraud case, as long as there is no change to the TWP fraud coding.

You can use the eWork program to document the TWP and extended period of eligibility (EPE) SGA months; however, the process of coding the DCF to effectuate the suspension of the TWP fraud months is a manual process.

E. OCO CSI procedure for inputting TWP fraud months

From the DCF menu, select The Verify/Update Earnings (VERN) screen for the first TWP month that is not payable due to the fraud conviction.

On VERN screen:

• Input the conviction date into the FRAUD DECISION DATE field (MMDDCCYY);

• In the VRFD field over key the “Y” with an “F”;

• Use the PF8 function to input additional TWP months that are not payable, and over key each “Y” with an “F”;

• Hit ENTER when you have recorded all of the non-payable TWP months covered by the fraud conviction. Since this action initiates a payment change, you will need to confirm your action by clicking PF9; and

• Release notice (see subsection D in this section for notice language).

If we did not record the TWP months as part of a previous work review, input the FRAUD DECISION DATE, and record the “F” in VRFD field and the appropriate WORK DET code (‘1’ through ‘9’).

F. Notifying the beneficiary of an overpayment

OCO CSI sends a manual notice to the beneficiary that includes paragraph TWP010. The notice explains why we cannot pay the beneficiary benefits for the TWP months. The notice should include appeal rights, but does not include a waiver right paragraph. For information on title II overpayments, see GN 02201.009.

TWP010 states:  Section 222(c)(5) of the Social Security Act provides that a person who is convicted by a Federal court of fraudulently concealing work activity during the trial work period, will not receive benefits for any months of work activity during the trial work period that occur on or after March 2004 and are before the date of conviction. You are not due benefits for the following trial work period months: (list the non-payable months of the TWP).

G. OCO CSI procedure for court reversals

1. If the court overturns the fraud conviction, the TWP months are payable. Apply the following procedures to remove the suspension months. On the VERN Screen:

• Delete the date in the FRAUD DECISION DATE field and leave the field blank.

• In the VRFD field, over key the “F” with a “Y” for those TWP months that are payable.

• PF8 through each TWP month that needs to be reversed, then hit ENTER to record the decision and PF9 to confirm. Hitting “enter” after the first month will only reverse the decision for that TWP month.

• Send a manual notice.

2. OCO CSI procedure for correcting an erroneous input

If the technician did not properly record the TWP months (i.e., months we should have suspended and did not, or we suspended months in error) or the fraud decision date was incorrectly recorded, follow these procedures to correct the input (only over key incorrect fields). On the VERN Screen:

• Correct the fraud decision date: Over key the date with the correct date, or delete the date using the DELETE key;

• Correct TWP fraud months: Start on the VERN screen for the first TWP month that needs correction. Over key the “F” or “Y” with the correct entry. PF8 through all months that need correction; and

• Hit ENTER once you complete all the corrections and PF9 to confirm.

Based on your corrections, you may need to release a revised overpayment notification notice.

3. TWP fraud processing exception

The DCF will not re-send any TWP fraud data if the update fails and it does not update the MBR. The PC receives a PCACS exception. Forward all exceptions regarding a TWP fraud input to OCO. All PCACS TWP Fraud exceptions must be input via MACADE – DO NOT re-input to the DCF.

See also:

• SM 03005.285 Trial Work Period Fraud Suspension Transactions

• SM 00880.000 MACADE- Table of Contents

• SM 00883.000 Overview of COMMON Screen Process-Table of Contents

4. Subsequent work review after a TWP fraud conviction

When you establish a work review in eWork, and the DCF indicates TWP fraud (e.g., either the VRFD GRS or VRFD SE field has an “F”), the following alert shows on the Initiate Work Review page:

“This is a Trial Work Period (TWP) Fraud Case. You will be able to develop and process this case in eWork; however, no earnings information will be pushed to DCF.”

When you attempt to adjudicate a case that involves prior TWP fraud coding in eWork, a pop up box shows:

“EXCLUSION: The DCF shows that there was a fraud decision on this case for the TWP. This is an exclusion from eWork input to the DCF. You will need to manually input the earnings to the DCF. The inputs to the DCF could directly affect payments. eWork continues to process the case when you click OK.”