In the United States, over 8 million people receive social security disability benefits (SSDI). Individuals who receive benefits due to a disability account for about 13% of the total benefits paid from the Social Security Administration (SSA). 

While an extremely high percentage of benefits paid are legitimately for individuals who need them, there are cases of disability benefits fraud that the SSA has to deal with. The penalty for fraudulently apply for or receiving SSDI benefits is severe. There are even cases where an employee from the SSA may be involved in the fraudulent scheme. 

disability benefits fraud

Here are some of the common scenarios where fraud takes place in the SSDI application process. 

Medical Records are Falsified

An individual’s medical records are directly tied to the success or failure of their disability benefits application. After all, benefits are reserved for those with a debilitating condition that prevents them from working. 

When disability benefits fraud occurs, medical records are often falsified to show that the individuals are disabled when they may not be, or making their condition appear more severe than is reality. Usually, the individual’s doctor may be involved in the process, helping them falsify medical records to make them appear legitimate. 

SSDI Application is Falsified

During the application process, it is an individual’s responsibility to put complete and accurate information. In fraud cases, a person may intentionally misrepresent their situation to increase their chances of being approved or increase the benefit amount they would receive once approved. 

The amount someone receives from the SSA once approved for disability benefits is directly related to their past income and work history. Therefore, there have been cases where someone attempts to misrepresent their past income to receive a larger monthly check. This is fairly easy to check on and will likely be caught. 

Change in Medical Condition is Not Reported

Given that SSDI benefits are specific to each individual and their condition, it is required that someone report to the SSA if their medical condition changes. Often, people may not want to report changes to the SSA, as a change in their condition could discontinue their benefits. But again, it is always best to report to the SSA, as not doing so is considered fraudulent. 

Often, a change in medical condition doesn’t actually lead to the cancellation of benefits, and it is possible for the condition to have worsened in the eyes of the SSA, meaning they may qualify for additional benefits. 

Change in Employment Status is Not Reported

adult age 50

While many disability recipients do not work or physically cannot do any kind of work, there are parameters where someone is able to earn a small income, depending on status. If the person does not meet the SSA’s substantial gainful activity threshold, they may be awarded disability benefits. But, there are situations where individuals start earning income that is above the threshold or get paid cash to jobs while receiving benefits. Doing either of these activities without reporting them to the SSA is considered fraud. 

Family is Receiving Benefits for Deceased SSDI Recipient

If the person whose name is on the disability check is no longer alive, it is considered fraud to continue to cash their disability checks. In many cases, a surviving spouse would still qualify for some form of widower benefit, so it is important to notify the SSA if benefits checks are still being received, but the person is no longer alive. 

What Happens to Someone Who Commits Disability Benefits Fraud? 

Social security disability benefits fraud is a serious offense that has genuine consequences. Someone who commits disability benefits fraud may receive up to five years in prison and up to $250,000 in fines. The penalty can be even more severe for SSA employees and doctors, who can receive up to 10 years in prison and face civil court filings against them, in addition to the loss of employment and license. 

Anyone aware of disability benefits fraud is encouraged to report it to the SSA by calling 800-269-0271.

To assist with benefits application and ensure that everything is properly in place, individuals are encouraged to contact Tabak Law at 800-345-1430.

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