Articles from prior issues of The Advocate

November/December 1998

SSA/OIG Targets Fraud
by Shari Bratt, Great Plains Publication Representative

DAN DEVLIN, DEPUTY ASSISTANT in the Inspector General's Office for Audit, spoke to conference attendees on fraud and programs for its prevention. There is a master plan in effect in three phases: Prevention, Detection, and Enforcement. The Prevention phase deals with conducting studies and audits to identify why fraud has occurred and how to avoid it in the future. After successful investigations, an “audit autopsy” is conducted to see what broke down and how to prevent it in the future. As a result of audits and SSA actions in obtaining records to identify prisoners, SSA’s actuary estimates the agency will save approximately 3.4 billion dollars for 1995-2001. The Office of Audit, under the Joint Vulnerability Agreement, identified and ceased payments to 90 members of a “family” who were fraudulently obtaining benefits. A payment accuracy task force exists to address errors in payment because of inattention to detail. Even minor errors can cause enormous cost to Social Security. Under the Detection phase of investigation, there are several operations in existence including Operation Border Vigil, Operation Contender, Operation Water Witch, Operation Clean Slate, and Operation Octopus.

Operation Border Vigil is designed to expand U.S. residency verifications for SSI recipients and/or applicants. It is also designed to determine fraud profiles between Canada and the U.S. border as there are U.S. citizens living in Canada and using mail drops in Niagara Falls. They may also have bank accounts in the U.S. or are using ATMs.

Project Stop looks at abuses on the Mexican border and is targeting two zip codes with common addresses. It is designed to target individuals receiving fraudulent benefits due to improper residency or other eligibility requirements. Operation Water Witch is designed to identify illegal benefit claims by career criminals and fugitives.

Operation Clean Slate focuses on the practices of SSA employees using information to collaborate in financial crimes with outsiders such as manipulation of the electronic records systems. Operation Octopus deals with identifying fraud and is designed to identify individuals obtaining SSNs or using SSNs of others for fraudulent purposes. Some of these problems are international in nature and involve Eastern European countries. Former criminals from the Soviet Bloc were assuming new identities sold to them by a travel agent in order to obtain benefits fraudulently.

Operation Contender is designed to identify those involved in disability fraud, such as lawyers, doctors, representative payees, and interpreters.

Other investigations involve those who are working and continuing to receive benefits, and individuals who get on the rolls by collaborating with a middleman or intermediaries. An example given was “Dr. Triage”, who stole forms from a VA Hospital and forged his own medical records. He actually signed these “medical records” under the name of “Dr. Triage”, and was working at a gas station. Another man was receiving Worker’s Compensation benefits under one ID, and disability benefits under another. Investigation units are in Oakland, Chicago, Baton Rouge, Atlanta, and New York, with plans to add two more units each year. They will be staffed by one OIG Special Agent, two state law enforcement officials, and two SSA/DDS technicians with administrative support from the DDS. Types of cases that may warrant investigation are those with a lack of medical history for the disability, those with a change in diagnosis after the applicant has secured an attorney, “boiler plate evidence” (evidence matching almost word for word the information in the listings), treating physicians with claims volume significantly above average, and CE physicians who always find disabling conditions. Under the Enforcement category of investigations are areas of Civil Monetary Penalties and Administrative Sanction. Under Section 1129 of the Social Security Act, the Commissioner can assess fines for specific types of wrong doings, including making false statements or omissions to apply for benefits, or misleading advertisements. Administrative sanctions involvement includes the OIG’s attempt to expand authority to impose a period of ineligibility for someone who has obtained benefits fraudulently and to expand authority in identifying fraud. Accomplishments of this department include a return on investments of $20 for every $1 invested in the IG Office. In fiscal year 1997, they obtained 2,507 convictions. In fiscal years 1996 and 1997, they increased savings by almost $600 million. Their challenges are increased Hotline allegations, which are of a massive volume. Almost 30,000 allegations are received each month. These allegations involve SSN/ID fraud, fraud in the disability program, and SSA employee fraud. NADE conference attendees were asked to assist by analyzing alleged improprieties and continuing to report fraudulent activities.

The Hotline number is (800) 269-0271

The FAX is (410) 597-0118

The e-mail address is oig.hotline @ssa.gov

The mailing address is:

SSA Fraud Hotline
PO Box 17768
Baltimore, MD 21235