BASIC (01-01)

A. INTRODUCTION

Determinations in SVB cases can be reopened at any time if there is fraud on the part of any person. See VB 02507.010A.5 for a definition of fraud.

B. PROCEDURE

1. Referral to the Office of Investigations Field Division (OIFD)

• If fraud is suspected, complete all development for the period in question per instructions in GN 04110.010C.

  CAUTION: If the SVB claimant or beneficiary is the individual suspected of fraud, prosecution is unlikely since the suspect will in most cases be over age 70. (See VB 02507.020B.2. and GN 04110.010C.3.e.) Also, in developing for fraud, take into account any physical, mental, educational or linguistic limitation (including lack of facility with English) which would bring into question the individual's knowledge of the suspected wrongdoing.

• If there is sufficient evidence to substantiate the allegation or suspicion of fraud (and management approval has been secured), the FO should follow GN 04111.010B. in reporting the case to OIFD.

• If OIFD determines that fraud exists, unlimited reopening is available, even if the fraud is not prosecuted in a criminal proceeding.

• If OIFD determines that fraud does not exist, unlimited reopening based on fraud is not available, and the FO must consider the possibility of similar fault. (See VB 02507.025.)

2. Curtailed Development

Even if it appears that fraud exists, fraud development may be curtailed in certain circumstances.

• If the suspect meets the criteria in GN 04110.010C.3., the SSA employee has the option not to develop fraud.

• If prosecution is unlikely or inadvisable because the case meets the criteria in GN 04110.010C.3.e., development should be limited to the period that is open to correction under administrative finality.

3. Handling Overpayment After Determination of Fraud or Similar Fault

After OIFD makes a determination of fraud or the FO makes a determination of similar fault, follow the procedures in VB 02000.000 ff. in recovering the overpayment.

C. SUMMARY OF RELATED PROCEDURES

• Procedures for Developing Fraud -- GN 04110.010

• Completion of Form SSA-8551, Referral of Potential Violations -- GN 04111.065, GN 04124.001

  NOTE: When completing the SSA-8551, annotate the form that SVB payments are involved rather than SSI (Item 6).

• FO Referral to OIFD -- GN 04110.010.

• Authority to Dispose of Violation Aspects of Cases — GN 04110.010C.3.

• Disposition of Potential Violation Cases -- GN 04111.000