ROBERT P.

WALSH ATTORNEY
2 West Michigan Avenue Suite 301 Battle Creek, Michigan 49017 Telephone (269) 962-9693 Telecopier (269) 962-9592 E-Mail: rpwalsh@SBCglobal.net

March 17, 2014 U.S. Department of Veterans Affairs ATTN: Director, Regulations Management (02REG) 810 Vermont Avenue, N.W. Room 1068 Washington, DC 20420 Telephone (202) 461-4902 Telecopier (202) 273-9026 http://www.regulations.gov RE: NPRM RIN 2900-AO13 Gentlemen: I have reviewed the November 27, 2013, Notice of Proposed Rule Making (NPRM) and feel that a few comments are warranted. WILLFUL MISCONDUCT. A disturbing trend in benefits claims adjudication at the U.S. Department of Veterans Affairs (VA) has been noted in my office regarding willful misconduct determinations. Willful misconduct in the context of the adjudication of a claim for service connected veterans disability benefits is almost always a determination reserved to the service department. I have observed benefits claims being wrongfully denied when local Veterans Benefits Administration (VBA) staff have interposed their personal beliefs and biases in to the claims process.
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RE: NPRM RIN 2900-AO13 They have revisited final service department determinations that no willful misconduct was involved in an injury and declared that willful misconduct was a bar to benefits. One example is the sailor who was returning to his ship in San Diego, California. He had been drinking. He was assaulted by a gang of locals. He suffered a traumatic brain injury, dislocation of the right shoulder with permanent loss of function, and lacerations. The officer of the deck on his ship made a notation of willful misconduct when he reported aboard. The next day that preliminary determination was emphatically overruled by the sailors superior officer. That veteran was denied benefits for decades because regional office employees in Detroit, Michigan, chose to re-litigate that determination and raise willful misconduct as a bar to benefits. The regulations and manual M-21 should clearly indicate that a claimant being denied benefits by virtue of a willful misconduct determination is to be afforded due process. Full due process as required by the Administrative Procedures Act (APA) 5 U.S.C. 551-599; 701-706, and the Fifth Amendment to the United States Constitution. See the discussion below regarding benefits fraud. Letters informing a claimant that we propose to make a determination of willful misconduct regarding your claim or your claim has been denied as we have made a finding of willful misconduct are contrary to law and devoid of fundamental fairness. Aliens that are the subject of deportation proceedings are afforded more due process than our disabled veterans. Veterans who elect to file a claim for disability benefits are not third-class citizens. They do not waive or surrender their right to due process by filing an application for benefits. When a determination of willful misconduct is a factor in the adjudication of their claims, veterans and their dependents are entitled to due process of law. They must be afforded adequate notice, an opportunity to review the record and evidence which forms the basis for the willful misconduct determination, and a hearing on the record. The proposed regulations are inadequate and must be revised.

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RE: NPRM RIN 2900-AO13 The regulations and instructions in M-21 should set forth clear guidance on the due process to be afforded a claimant when a finding of willful misconduct is proposed. A service member receives the due process afforded by the Uniform Code of Military Justice (UCMJ) and the relevant service department regulations. The determinations now being made by regional office staff are made in camera. No proper notice is afforded to the veteran. No opportunity to review the relevant evidence, the specific proposed finding, or an explanation of the potential consequences of the determination are provided by VBA staff. A brief annotation in a rating decision or statement of the case that benefits have been denied based on a finding of willful misconduct is a denial of the due process mandated by the APA. BENEFITS FRAUD ADJUDICATIONS BY THE U.S. DEPARTMENT OF VETERANS AFFAIRS. The process for investigating and adjudicating allegations of benefits fraud detailed in the NPRM are expedient. They are illegal and unconstitutional, but expedient. In a report concerning workers compensation fraud, the VA OIG has stated that: Federal statutes prohibit employing agencies from conducting criminal fraud investigations, limiting agencies solely to the review of the extent of medical impairment of the claimant. Criminal fraud investigations may be conducted only by authorized law enforcement agencies. Signed by Michael L. Staley, Assistant Inspector General for Auditing, U.S. Department of Veterans Affairs, August 13, 2004.

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RE: NPRM RIN 2900-AO13 The Veterans Benefits Administration has a very limited role to play in the adjudication of an allegation of benefits fraud. The VA Office of Inspector General (VA OIG) is tasked with collecting and investigating fraud allegations. The VA OIG may only act within the constraints of the Inspector General Act of 1978, 5 U. S.C. Appendix. The VA OIG is not a law enforcement entity. Benefits fraud allegations received and reviewed by the VA OIG must be forwarded to the VA Office of General Counsel (VA OGC) for further review and action if required. If a fraud allegation is adjudicated and found to be true, an overpayment amount is calculated and the fraud determination is sent to the Veterans Benefits Administration for implementation. This role of the general counsel is set forth in 38 C.F.R. 14.561, and in greater detail in 38 C.F.R. 42.1-42.47. The proposed regulations continue to ignore the Congressional mandate for the adjudication of benefits fraud. They attempt to perpetuate the illegal and unconstitutional ad hoc procedures which appear to have been used by the U.S. Department of Veterans Affairs to deal with allegations of benefits fraud on an ex parte basis for decades. Since at least the 1930's the United States Congress has enacted legislation which mandates the procedures to be followed by all agencies when adjudicating allegations of benefits fraud. Title 31 of the United States Code also includes statutory provisions for the calculation, reporting, and collecting of a debt owed to the U.S. Government arising from benefits fraud.1 See generally: 31 U.S.C. 3711, the Debt Collection Improvement Act of 1996; 31 U.S.C. 3729-3733, False Claims Act (1863)(October 27, 1986); 31 U.S.C. 3801-3812, Program Fraud Civil Remedies Act; 5 C.F.R. 185, Program Fraud Civil Remedies; 28 C.F.R. 11.4-110.9, Administration of Debt Collection; 28 C.F.R. 11.10, IRS Tax Refund Offset Provisions for Collection of Debts; 28 C.F.R. 71, Implementation of the Provisions of the Program Fraud Civil Remedies Act of 1986; 31 C.F.R. 16, Regulations Implementing the Program Fraud Civil Remedies Act of 1986; 31 C.F.R. 285.5, Centralized Offset of Federal Payments to Collect Non Tax Debts Owed to the United States (TOPS); and, 31 C.F.R. 900-904, Federal Claims Collection Standards.
1

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RE: NPRM RIN 2900-AO13 The importance of compliance with these statutes and regulations is twofold. First, the laws were put in place to provide uniformity and afford due process of law to the beneficiaries of federal programs accused of fraud. Second, the comprehensive statutory and regulatory scheme affords the accused due process of law in compliance with the mandates of the United States Constitution, Fifth Amendment. This body of law sets forth the exclusive procedures for the adjudication and recovery of debt from benefits fraud and the process for referring such a case to the U.S. Department of Justice for criminal or civil prosecution. In 1986 the then Veterans Administration added the benefits fraud regulations at 38 C.F.R. 42.1-42.47. The VA regulations were amended later to reflect the creation of the U.S. Department of Veterans Affairs. A response to a Freedom of Information Act inquiry to the VA covering a four year period indicated that these regulations had not been used. No Administrative Law Judge (ALJ) had ever been appointed to adjudicate a benefits fraud case under the VA regulations during that four year period. During the same period of time the VA OIG had issued numerous press releases to announce federal criminal convictions of veterans and family members for benefits fraud. I find it very remarkable that this NPRM does not mention the Congressionally mandated due process procedures for the adjudication of benefits fraud allegations set forth in 38 C.F.R. 42.1-42.47 even once. The VA promulgated the regulations in 1986. It appears that the VA has never afforded any veteran accused of benefits fraud the due process mandated by Congress and found in these regulations. During the same period of time hundreds (if not thousands) of veterans and family members have been accused of benefits fraud by the agency. Many of these veterans have had those benefits fraud allegations forwarded to the U.S. Department of Justice for criminal prosecution prior to the completion of the administrative adjudication of the allegation. By that I mean even the current ad hoc VBA procedures. Not only are the proper procedures ignored, VA OIG circumvents the established U.S. Department of Justice (DOJ) procedures for referral of a benefits fraud case for criminal prosecution.

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RE: NPRM RIN 2900-AO13 Low level employees of the VA Office of Inspector General circumvent the VA General Counsel and enter in to direct discussions with United States Attorneys around the country to obtain indictments. In one case VA OIG investigators convinced a county prosecutor to have a military retiree arrested and charged in an Indiana state court. The allegation was travel pay fraud relating to treatment at the VA medical center in Indianapolis. Not federal court, state court. The current ad hoc process for benefits fraud adjudications being used at the VBA is set forth in the NPRM. It is unlawful. It ignores the Congressionally mandated due process found in 38 C.F.R. 42.1-42.47. It is contrary to the due process mandates of the Administrative Procedures Act. 2 As discussed below, there are two major flaws in the Frankenstein Monster procedures used by the VA. First, they result in incomplete and legally infirm adjudications of the benefits fraud allegation. Second, they circumvent the Congressionally mandated procedures for the perfecting and collecting of a benefits fraud debt by a federal agency. This is demonstrated by a review of Board of Veterans Appeal (BVA) and U.S. Court of Appeals for Veterans Claims (CAVC) decisions concerning overpayments. When these cases are appealed the veteran is often successful in having the debt thrown out. By that time the statute of limitations has often run. The taxpayers suffer the loss (if indeed the debt was ever actually owed to the agency).

For a comprehensive review of proper benefits fraud investigation and adjudication see United States Attorneys Bulletin, Vol. 52, No. 6, November 2004, Social Security Fraud, attached.
2

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RE: NPRM RIN 2900-AO13 FRAUD, A DISFAVORED TORT, IS QUASI CRIMINAL IN NATURE. The NPRM reports that a previous public comment had indicated that fraud is quasi criminal in nature. The author of the NPRM brushed that comment aside. Fraud is a disfavored tort. Actionable fraud is defined as deception practiced in order to induce another to part with property . . . . A false representation made with an intention to deceive. . . Blacks Law Dictionary , 6th Ed., West, 1990. Fraud must be plead with specificity, as a special matter. Federal Rule of Civil Procedure 9 (b) provides that: (b) Fraud or Mistake; Conditions of Mind. In alleging fraud or mistake, a party must state with particularity the circumstances constituting fraud or mistake. Malice, intent, knowledge, and other conditions of a person's mind may be alleged generally. The VA OIG has been referring cases directly to U.S. Attorneys for criminal prosecution using a theory of wire fraud based on the government wide effort to have all recipients of benefits receive their payments via direct deposit. See 18 U. S.C. 1343. The NPRM refers to Roberts v. Shinseki, 23 Vet. App. 416 (2010) several times. In the interest of clarity some discussion of that case is in order. Contrary to the Congressional intent, Mr. Roberts was forced to defend himself in two forums simultaneously. He was appealing the termination of his service connected disability benefits and vague benefits fraud allegation at the VA regional office, Board of Veterans Appeals, and at the U.S. Court of Appeals for Veterans Claims. Even though the initial stage of the adjudication of the benefits fraud and compensation termination action had not been fully adjudicated, he had already been indicted for the same conduct by the U.S. Attorney for the Eastern District of Wisconsin. Mr. Roberts was defending himself in Federal District Court for the Eastern District of Wisconsin and later appealing to the U.S. Court of Appeals for the Seventh Circuit, and the Supreme Court of the United States at the same time
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RE: NPRM RIN 2900-AO13 his administrative case was active at VA. Mr. Roberts was convicted of wire fraud and served over four years in a federal penitentiary. He has been released. Some of his original benefits issues are still being adjudicated by the Veterans Benefits Administration almost ten years later. There has never been a final agency decision as to the reduction of his VA benefits payments. The Secretary of Veterans Affairs never properly adjudicated the benefits fraud allegation and termination of benefits. The Secretary of Veterans Affairs has never certified damages from benefits fraud in a sum certain to the Department of Justice in the Roberts case as required by law. There was never an administrative determination as to the specific amount of VA benefits compensation (if any) Mr. Roberts was entitled to during the period covered by the federal criminal indictment. Only ad hoc estimates were ever made, and not by those authorized by statute to make such determinations. Should he prevail in the portion of his case remanded by the CAVC in 2010 his service connected compensation benefits may be restored at the 100% rate of pay. At that point he will have served four years in a federal penitentiary for having accepted payment for benefits to which he was lawfully entitled. No monetary loss to the VA will exist. But Mr. Roberts will still be charged with a debt of over $ 250,000.00. And now he is being charged twice, once by the DOJ and yet again for the same debt (but in a much different amount) by the VA Debt Management Center. See Roberts v. Shinseki, 643 F.3d 1334 (Fed. Cir. 2011) (Cert. Den.); Roberts v. the United States of America, No. 08-788 Cert. Den. (U.S. Dec. 15, 2008); United States v. Roberts, U.S. District Court, Eastern District of Wisconsin, docket 05-CR-115; United States v. Roberts, 534 F.3d 560 (7th Cir. July 7 2008) (Cert. Denied 08-788, December 15, 2008).

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RE: NPRM RIN 2900-AO13 As demonstrated by the dates on the citations above, the CAVC did not render a decision until 2010 for a case filed in May of 2005. The criminal appeals were exhausted in December of 2008. Documents obtained in criminal discovery indicate that VBA executives were directly involved in the effort of the VA OIG to have Mr. Roberts indicted at the same time they were communicating with him regarding his pending benefits claims. The only investigation ever conducted in the criminal case was the administrative investigation done by the Chicago office of the VA OIG. Mr. Roberts was represented by the American Legion at his BVA hearing. He had already been indicted. He had to obtain leave from the federal district court to attend his BVA hearing in Washington. At that BVA hearing he was not permitted access to his VA claims file. The original file had been seized by the VA OIG and the Board was using an incomplete photocopy.3 Mr. Roberts had obtained the VA OIG report on his alleged fraud during criminal discovery. The VBA and Board never provided him a copy of the VA OIG report which formed the factual and legal basis for the termination of his compensation benefits and was a central issue in that appeal. The DOJ manual indicates that for wire fraud an investigation must be conducted by either the Federal Bureau of Investigation or the U.S. Treasury Department. To my knowledge the VA OIG investigator conducted the only investigation in the Roberts case. A VA OIG employee later provided the only testimony to the federal grand jury. He made material misrepresentations to the grand jury when he testified that the adjudication of the benefits case was completed. It is still pending at the time this is being written.

During criminal discovery and later when reviewing the record provided to the CAVC by VA OGC, Mr. Roberts and his attorneys would find hundreds of pages of evidence missing from the VA record. The record at the CAVC was supplemented twice by counsel for Mr. Roberts. Other critical documents were identified later and submitted to the Board during this remand period.
3

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RE: NPRM RIN 2900-AO13 The VA never actually adjudicated the allegation of fraud made against Mr. Roberts. In the proposal to sever his benefits the regional office staff indicated that his benefits were being severed. To my knowledge there was no involvement by the VA OGC in this case until it was docketed at the CAVC in May of 2005. On several occasions during the CAVC appeal counsel for the Secretary asserted that the VA Office of General Counsel had no role to play in the adjudication of benefits fraud allegations. Mr. Roberts and the undersigned assert that a plain reading of the relevant law indicates otherwise. Had the procedures set forth in 38 C.F.R. 42.1-42.47 been complied with Mr. Roberts would have been provided proper and detailed written notice of the allegations against him. He would have been given notice of his right to counsel. He would have been afforded an opportunity to be heard by an Administrative Law Judge as defined in the APA.4 A neutral fact finder, not an agency employee such as a BVA veterans law judge. An investigation of an allegation of benefits fraud is inherently adversarial. Such an investigation carries with it, as a minimum, the potential for a loss of benefits, a property interest. It also carries with it the potential for the loss of liberty such as that suffered by Mr. Roberts. See Mathews v. Eldridge, 424 U.S. 319, 96 S. Ct. 893, 47 L. Ed. 2d 18 (1976); Goldberg v. Kelly, 397 U.S. 254 (1970).5

Arzt, Robin J., What Veterans Would Gain From Administrative Procedure Act Adjudications, Tommy, Issue 2, 2002, Federal Bar Association, copy attached.
4

The Veterans Benefits Administration has a cumulative error rate of approximately 90% for the adjudication of benefits claims. Do the authors of this Notice of Proposed Rule Making actually suggest that these same employees should be entrusted to make benefits fraud determinations which entail the potential for such draconian monetary, civil, and criminal penalties?
5

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RE: NPRM RIN 2900-AO13 See also 38 C.F.R. 3.103(a) (2012) (Proceedings before VA are ex parte in nature, and it is the obligation of VA to assist a claimant in developing the facts pertinent to the claim and to render a decision which grants every benefit that can be supported in law while protecting the interests of the Government.); 38 C.F.R. 19.29(b) (2012) (requiring the agency to provide veterans with [a] summary of the applicable law and regulations.); Manio v. Derwinski, 1 Vet. App. 140, 144 (1991) (Rather than defending against the claims of veterans, the Secretary has a statutory duty to assist claimants during the course of the ex parte and non-adversarial claims resolution process at the regional office and before the BVA.). See also Brown v. Gardner, 513 U.S. 115, 115 S. Ct. 552 (1994); Cushman v. Shinseki, 576 F.3d 1290 (Fed . Cir. 2009). A VBA employee communicating directly with a U.S. Attorney in an effort to procure obtain a criminal indictment of a veteran for benefits fraud while actively adjudicating the same veterans benefits claims would appear to be adversarial by any reasonable definition. On August 26, 2005, the BVA, B. Bohan, Veterans Law Judge, issued a decision under Docket Number 03-04 265 which, inter alia, upheld the termination of disability compensation benefits of Mr. Roberts by the Agency of Original Jurisdiction, the VARO Milwaukee, Wisconsin. The Board made: A finding of fraud in the May 1998 grant of service connection for post traumatic stress disorder (PTSD) and dysthymia and depression under the authority of 38 U.S.C. 501; A finding of Clear and Unmistakable Error (CUE) in the same decision; and, that the criteria for severance of the award of PTSD had been met under color of, inter alia, 38 U.S.C. 501; and 38 C.F.R. 3.105 (d) and 3.957. The Board determined that Mr. Roberts was not on duty in Naples, Italy, on February 4, 1969, and that he had no stressor for PTSD.6 When called to testify in Federal District Court during the criminal trial none of the government witnesses testified that Mr. Roberts was not present in Naples Italy on February 4, 1969, the date of a fatal accident. They testified that they did not recall or that they did not know Roberts. These were many of the same individuals quoted in the VA OIG Mr. Roberts was not allowed to review or challenge during his VA adjudication.
6

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RE: NPRM RIN 2900-AO13 In the BVA decision dated September 28, 2012, Docket Number 03-04 265, the Board remand quoted the decision in Roberts v. Shinseki, 05-2425, 23 Vet. App. 416 (2010); Affirmed, Roberts v. Shinseki, 643 F.3d 1334 (Fed. Cir. 2011) Cert. Den.: Upon consideration of the foregoing, that part of the August 26, 2005, Board decision denying Mr. Robert's claim for disability compensation for dysthymia and depression on a direct basis is SET ASIDE and the matters are REMANDED for further adjudication. The remainder of the decision is AFFIRMED. See 38 U.S.C. 7252(a). [As found in Part IV. Conclusion section of the April 2010 Decision of the Court of Appeals for Veterans Claims]. The Board continued: Accordingly, remand is warranted for the Board to address service connection on a direct basis for dysthymia and depression. . . Clearly, the Court directed the Board to adjudicate the claim for service connection on a direct-incurrence basis. The Board notes this matter is inextricably intertwined with the claim for separate compensable evaluations for dysthymia and depression. The Court has held that a claim which is inextricably intertwined with another claim which remains undecided and pending before VA must be adjudicated prior to a final order on the pending claim. [September 2012 Remand Order from the Board of Veterans Appeals]. Mr. Roberts obtained the VA OIG report that accused him of benefits fraud in criminal discovery. The BVA rendered the decision which was affirmed in part and remanded in part by the CAVC based on the decision based primarily on that VA OIG report.

Whether Mr. Roberts was at his duty station during a time of emergency in 1969 would appear to be one of those determinations properly reserved for the service department. Mr. Roberts was not punished for his actions on February 4, 1969. In fact, the service record contains a favorable performance review dated only a few days later.
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RE: NPRM RIN 2900-AO13 The U.S. Supreme Court has long held that due process requires access to the record, and an opportunity to be heard in a neutral setting. See Gonzales v. United States, 348 U.S. 407 (1955) (conscientious objector contesting his classification before appeals board must be furnished copy of recommendation submitted by Department of Justice; only by being appraised of the arguments and conclusions upon which recommendations were based would he be enabled to present his case effectively). Also United States v. Nugent, 346 U.S. 1 (1953) (in auxiliary hearing which culminated in Justice Departments report and recommendation, it is sufficient that registrant be provided with resume of adverse evidence in FBI report because the imperative needs of mobilization and national vigilance mandate a minimum of litigious interruption). Even this truncated opportunity goes far beyond what a veteran accused of benefits fraud is permitted by the VA. Mr. Roberts would welcome the opportunity to defend himself before an Administrative Law Judge, not an agency employee. Because the mandatory procedures were not followed he now finds himself in the bizarre circumstance described above. The U.S. Attorney is collecting on the debt created by the criminal case. Now the VA has created a second debt. Neither debt was ever adjudicated or certified by the Secretary. The two debts are for different amounts. And both are attempting to collect the alleged monies improperly paid to Mr. Roberts based on his unadjudicated benefits fraud. At the same time health care providers are attempting to collect because CHAMPVA payments to his family were illegally clawed back by VA creating a large debt arising from once paid, but now unpaid, medical bills.

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RE: NPRM RIN 2900-AO13 CONCLUSION The Notice of Proposed Rule Making should be rescinded and the relevant sections rewritten to comply with the federal law of benefits fraud and the Fifth Amendment to the United States Constitution. This group of regulations should be re-written to incorporate the Congressionally mandated due process, debt determination and debt collection standards found in Title 31 of the United States Code and the APA. A bright line should be established which clearly indicates that the VA Office of General Counsel is the sole point of contact between the agency and the Department of Justice for the referral of cases for criminal investigation and possible prosecution. Mr. Justice Jackson in his dissent in Federal Crop Insurance Corp. v. Merrill et al, 332 U.S. 380; 68 S. Ct. 1 (1947), could have been writing of this case when he observed: It is very well to say that those who deal with the Government should turn square corners. But there is no reason why the square corners should constitute a one way street. Respectfully submitted, /S/ ROBERT P. WALSH ROBERT P. WALSH, Esq. 2 Michigan Avenue West Suite 301 Battle Creek, Michigan 49017 Telephone (269) 962-9693 Telecopier (269) 962-9693 E-mail: rpwalsh@sbcglobal.net Date: 03/17/2014

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RE: NPRM RIN 2900-AO13 Enclosures: 1. Arzt, Robin J., What Veterans Would Gain From Administrative Procedure Act Adjudications, Tommy, Issue 2, 2002, Federal Bar Association. United States Attorney Bulletin, Social Security Fraud, November 2004.

2.

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. 17

Federal Bar Association Veterans Law Section

A Lawyer's Guide to Veterans Affairs

Inside This Issue

5 CVA to Convene"
Seventh Judicial Conference'

What Veterans Would Gain From Administrative Procedure Act Adjudications

By Robin J. Arzt

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8 Beware the
Voluntary Dismissal, You Mav Get What You Ask For Veterans Law-at FBA.Convention

published in
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the FederarBin'Ass6eLition. the VeteraNS Law Section, 01 any app:, fvf:firin. with . which 'are associated.

,Federal Bar
Veteeans Law Section

Association

here is a crisis of public confidence in the timeliness, fairness, and quality of the VA disability claims process. Our veterans who apply for VA disability benefits are confronted with an inefficient, inaccurate process that undermines administrative fairness and the public's confidence in that fairness. 1. Untimely decisions. There are lengthy case processing times for initial claims at the Department of Veterans Affairs (VA) regional office level and for appeals to the Board of Veterans' Appeals (BVA) and U.S. Court of Appeals for Veterans Claims (Veterans Court) that add up to years. Undecided backlogged initial claims number in the hundreds of thousands and had climbed to 600,000 by the end of 2001. The BVA and Veterans Court also have significant backlogs and increasing case processing times in recent years. There is no limit to the number of appeals. Numerous veterans reportedly die every year while awaiting determinations of their VA disability claims at all levels. 2. Perception of unfairness. The BVA achieved the uniquely low score of 35 in the December 2001 American Customer Satisfaction Index compiled annually regarding federal agencies by the University of Michigan Business School and American Society for Quality.1 The study's director opined that he never before saw anything like this low score. However, the chairman of the BVA explained it away by saying that a 35 is not bad when only 22 percent of veterans received an increase in benefits at the BVA level,2 which shows an insensitivity to the public perception of unfairness that this remarkably low satisfaction

score appears to signify. In 2000, the BVA favorably ruled on 26 percent of the benefits claims. Veterans are virtually barred from hiring lawyers to help prosecute their claims through the VA administrative process until their case reaches the Veterans Court, which leaves some veterans feeling that they are being denied counsel of their choice. The lack of legal counsel during the administrative process has been estimated to add substantially to the case processing time. 3. Poor decision quality. The quality of the regional office determinations and BVA decisions as measured by their accuracy is poor. Despite years of VA effort to improve claims processing accuracy and timeliness, VA reported a 41 percent error rate at the regional office level in fiscal year 2000, according to a June 2000 GAO report.3 In 2000, the BVA vacated 30 percent of the regional office determinations and remanded the cases for another determination. In the same year, the Veterans Court vacated a huge 64 percent of the BVA decisions on appeal, most upon procedural grounds, and remanded the cases for further proceedings.4 This year, VA increased the monthly regional office disposition rate from 29,000 to 70,000, which reduced the backlog from 600,000 to 389,000 by June 3, but apparently at the cost of a further erosion in the quality of decisions. On June 6, an American Legion official testified before the House Veterans' Affairs Subcommittee that a quality review team that reviewed one regional office found evidence of premature and erroneous denials of claims after cursory review in order to meet stringent VA production quotas, a general lack of compliance with the Veterans'
continued on page 2

TOMMYFederal Bar Association Veterans Law Section Adjudicationscontinued from page 1 chair also has cited the SSA APA process as a mode1.8 By APA mandate, the AU is an indef pendent, impartial adjudicator in the administrative process, and there is a separation of an agency's adjudicative function from its policy-making, policy-implementation, rulemaking, investigation, and prosecutorial functions. The remainder of this article describes the benefits that these features of the APA would afford the veterans who file VA disability claims. The ALJ is the only impartial, independent adjudicator available to a claimant in the federal administrative process and the only person who stands between the claimant and the whim of agency bias and policy. The APA puts many protections in place to ensure that ALJs are independent, competent, and impartial in adjudicating administrative claims. The decisional independence granted to ALJs is designed to maintain public confidence in the essential fairness and high quality of the process through which benefits are allocated by ensuring impartial decisionmaking. APA creates a comprehensive procedural bulwark to protect ALJs frorri agency interference. The high professional quality of ALJs and their decisional independence are ensured through the following APA safeguards. 1. ALJs are appointed as a result of a competitive merit selection process administered by the Office of Personnel Management (OPM), rather than by the hiring agencies. Securing fair and competent hearing personnel through a nonpolitical appointment process is the heart of the formal administrative adjudication process. The BVA chairman is appointed by the president with the Senate's advice and consent.9 The other BVA members are appointed by the VA secretary on the BVA chairman's recommendation and president's approval.10 The BVA members thus are not appointed through competitive merit selection process. However, in the event that the BVA hearing process were made subject to the APA, the sitting BVA members should be permitted an equitable opportunity to qualify as APA ALJs. 2. ALJs have career permanent civil service appointments without a probationary period to prevent agency dismissal of

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Claims Assistance Act of 2000, and what may be "an orchestrated policy of manipulation of...production figures as a means of meeting...mandated production quotas...."5 The current public uproar that has spilled into the media about the perceived lack of fairness, poor decision quality, untimeliness, lack of independence, and weak due process in the VA disability claim process at the BVA appellate level exists precisely because of the lack of the procedural safeguards that now exist for Social Security claimants in the Administrative Procedure Act (APA). The APA was enacted in 1946 to achieve reasonable uniformity and fairness of the administrative process in the federal government for members of the American public with claims pending before federal agencies. The APA provides the minimum standards for federal administrative due process in the Executive Branch and delineates procedures for adjudicative administrative proceedings, namely individual case decisions about rights or liabilities as an agency's judicial function. This includes uniform standards for the conduct of adjudicatory proceedings, including the merit appointment of hearing examiners, who now are administrative law judges (ALJs). The APA sets forth a due process administrative procedure for the hearing and decision by ALJs of cases brought before the federal agencies to which the APA applies.6 VA's use of subordinated employees at its final level of administrative review, the BVA, together with the BVA's low favorable ruling rate and high remand rate, unsurprisingly has fostered the public perception that the BVA is an instrument and mouthpiece for VA. Our veterans deserve
full administrative due process before an

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Spectil thank's to the Paralyzer) Veterans I America for supporting the produL.tion ()I bis new letter.

independent decisionmaker for their disability claims. There now is a movement to apply the APA due process requirements to the BVA to address problems of quality, untimeliness, and the perception of unfairness. Using an APA process with ALJs modeled on the SSA system at the BVA level recently has been endorsed by respected academicians.? A former BVA

Issue #2 -2002 ALJs whose decisions are not favored by the agency. 3. All pay levels are set by statute and ALJ pay is regulated by OPM independent of agency recommendations or ratings. 4. Agencies are prohibited from giving performance evaluations of ALJs, or giving bonus pay and honorary awards to ALJs in the performance of adjudicatory functions. Before the APA, hearing officers were impeded in their exercise of independent judgment because they often were subordinate to executive officials within the agency. By statute, the BVA chairman controls and supervises the BVA, is accountable to the VA secretary, and is authorized to appoint a performance review panel to review BVA members' work.11 The BVA members thus are subordinate VA employees and have performance reviews by VA agency superiors on a regular basis that may result in their removal as BVA members for unacceptable job performance.12 5. An All is not responsible to, or subject to the supervision or direction of, employees or agents engaged in the performance of policy-making, policy-implementation, investigative, or prosecution functions for the agency when conducting a hearing or deciding a case. Thus, the public's perception of fairness in the BVA process will be enhanced by due process hearings and decisions by APA ALJs. 6. Procedural safeguards to prevent ex parte communications about the merits of a claim with the ALJ, agency and employees involved in the decisionmaking process. An ALJ may not consult any person or party, including other agency officials, concerning a fact at issue in a claimant's hearing, unless on notice and opportunity for all parties to participate. The prohibition of off-the-record or ex parte communications is a lynchpin of the integrity of an ALJ's decisional independence. Concerns have been expressed about VA's "quality review" for errors (as per the BVA Handbook) of all BVA decisions or remand orders that are drafted after a court remand but before they are issued by the BVA. The pre-decision review is performed by the Litigation Support Division that is located within the BVA under the BVA chairman. The Litigation Support Division refers files with "erroneous" draft BVA decisions or remand orders to the BVA's senior deputy vice chairman. Differences of opinion between a BVA member and the BVA's senior deputy vice chairman are finally determined by the latter. Concerns also have been expressed about the Litigation Support Division review of, and issuance of memoranda that comment upon, Veterans Court remand orders before they are issued, since the court remand orders govern BVA decisions and the BVA members apparently may also see the memoranda.13 Ex parte and off-the-record review of and comment upon the Veterans Court remand orders and BVA decisions and remand orders before they are issued by a non-adjudicator part of the BVA undermine BVA member decisional independence and public confidence in the fairness of VA adjudication. 7. ALJs are insulated from at will removal by the president and employing agency by the requirement that a due process hearing be held before the Merit Systems Protection Board before an adverse personnel action may be taken against an ALJ. This provision helps protect APA adjudications from political intrusion. BVA members' fixed terms were ended by statute in 1994. A removal action against a BVA member for a reason other than job performance is subject to the same procedural requirements that are afforded ALJs pursuant to 5 U.S.C. 7521 of the APA. The BVA member also has the procedural rights to notice of the reasons for removal, reasonable answer time, representation, and a timely written decision that are set forth in 5 U.S.C. 7513(b). 5 U.S.C. 554(a)(2) does not apply to a removal action for a reason other than job performance.14 8. The requirement that cases be rotated among all of the ALJs employed by an agency prevents an agency from "judge shopping" for a particular outcome or giving fewer cases to ALJs whose decisions the agency does not like. By regulation, the BVA chairman is empowered to assign cases to the BVA members and disqualify a BVA member from hearing and deciding a given case.15 9. The requirement that All functions may not be delegated to, or performed by, non-All employees prevents an agency

3 from avoiding giving cases to ALJs whose decisions the agency does not like. The BVA chairman is permitted to appoint VA employees as acting BVA members for a maximum of 90 days at a time, but such an individual may serve up to 270 days per year. Acting BVA members cannot be more than 20% of the total number of BVA members and acting BVA members.16 10. ALJs are placed in a separate part of an agency from the initial decisionmakers and policy-makers to provide administrative review that is free of actual or perceived bias. There is no separation of the BVA from the VA policy-making structure. 11. ALJs may not perform duties inconsistent with their duties as ALJs. Prior to the APA, there was considerable concern that those hearing administrative cases at the trial level could not exercise independent judgment because they were required to perform prosecutorial and investigative functions as well as their judicial work. The APA's procedural separation of an agency's adjudicative function from the policy-making, policy-implementation, rulemaking, investigation, and prosecutorial functions of an agency would provide many benefits for veterans who appeal to the BVA. 1. A full and fair hearing that is conducted by an ALJ appointed pursuant to the APA, free of political and policy implementation pressure by the agency. 2. A de novo hearing that is on the record. The BVA does de novo hearings on the record that are nonadversarial. Formal rules of evidence are not followed. However, unlike the SSA de novo ALJ hearing, a veteran must move for permission to submit evidence that was not considered by the regional office and show good cause for not filing the evidence at the earlier step. Good cause is limited to several specific reasons by regulation. Also, a veteran must waive his right to have the new evidence considered by the regional office in order to avoid a remand of the case and stay before the BVA.17 3. A right to representation by a lawyer or nonlawyer at the hearing and during the rest of the application and appeals procontinued on page 4

4 Adjudicationscontinued from page 3 cess. A veteran essentially is barred by statute from hiring a lawyer at the initial regional office claims level and the BVA level because the lawyer is not permitted to be paid for his services, unless the BVA already has issued a final decision in issues raised in the case and the lawyer was retained within one year of the final decision issue date.18 Thus, while BVA rules permit a veteran to be represented by an attorney, only three to five percent of veterans are so represented. Instead, in practice, most veterans who apply for VA disability benefits are limited to using nonattorney representatives from veterans service organizations chartered by Congress and state veterans organizations that represent the veterans.19 By contrast, the SSA disability process permits a claimant's attorney and nonattorney representative to either submit a fee petition without a statutory maximum amount for A LJ approval or to enter into a contingent fee agreement with his or her client to accept the lesser of $4,000 or 25 percent of the past due benefits in the event that the client is awarded benefits, which has resulted in a high participation by lawyers in SSA disability claims. Permitting attorney representation is not a denigration of the veterans groups that now represent the veterans in the bulk of the cases at the initial and BVA levels, but affords veterans the full range of representation of their choice and the option of having a representative who is not a lay person in building a record and dealing with the increasingly complex VA claims procedures. 4. A decision based upon an evidentiary record introduced before, at, and after the hearing. ALJs can subpoena records and would be empowered by the APA to require VA to develop the record before and after the hearing for the benefit of the claimants. 5. A written decision that states the facts and law relied upon, rulings on exceptions, the ALJ's rationale, and the ALJ's findings of fact, rulings on the law, and decision. A BVA decision is a written statement of the findings and conclusions on all material issues of fact and law, the

TOMMYFederal Bar Association Veterans Law Section reasons for the findings and conclusions, and an order granting or denying relief.20 6. Decisions in accordance with the applicable federal statutes, regulations, and case law. Subordinate employees who are without the decisional independence safeguards of ALJs will not be able to resist an agency's policy that may conflict with federal law without risking an insubordination charge. By statute, the BVA is bound by the regulations and instructions of the VA secretary and the "precedent opinions of the chief legal officer of the Department...," which is the VA general counse1.21 The Litigation Support Division reportedly seeks out issues that it identifies as needing a consistent VA position and asks the BVA chairman to request a precedential general counsel opinion that will bind the BVA members. The BVA chairman reportedly often asks for and obtains such precedential opinions from the general counsel. This statute and provision reduce BVA decisional independence to follow federal law. 7. Mandatory judicial review of the final administrative decisions by the agency. Given that the veterans disability claims process is one of the largest administrative adjudication systems in the United States, with hundreds of thousands of cases decided per year, VA is the face of the United States government to the veterans who seek benefits. How veterans view that face depends upon the quality of due process they receive, particularly when they seek a review of an unfavorable initial decision by VA. The use of an APA due process procedure with APA ALJs at the BVA appeals level will provide our nation's veterans high quality appellate due process and a sense of fair play.
Robin .1. Arzt is an administrative law judge with the Social Security Administration (SSA), Bronx Office of Hearings and Appeals. She holds a BA 1975, JD 1978, and MBA 1985, from New York University. The author's position with the SSA is stated for identification purposes only. This article was written in her private capacity. No official support or endorsement by the SSA is in existence or should be inferred. The views expressed in this article are those of the author and do not necessarily represent the views of the SSA or the United States.

1 Patrick Barta, Customer Satisfaction Index Suggests More Patience with U.S. Government, Wall

Street Journal (Dec. 17, 2001). 2 Del Jones, More Consumers Give Government Services Thumbs-Up, USA Today (Dec. 17, 2001). 3 "Veterans' Benefits: Training for Claims Processors Needs Evaluation," (GAO-01-601). 4 See, Joan Mazzolini, Veterans Discover Entirely New Battle to Obtain Benefits, The Plain Dealer (Cleveland) (May 13, 2001). See generally, Fox, The United States Board of Veterans'
Appeals: The Unfinished Struggle to Reconcile Speed and Justice During Intra-Agency Review,

Paralyzed Veterans of America, 25-32 (2000).

5 Veterans' Affairs Department Cleans Up Benefits Claims Backlog, Federal Employees News

Digest, www.fedonline.com (May 31, 2002); Tanya Ballard, VA Benefits Production Quotas Called into Question, Government Executive Magazine, www.govexec.com (6/7/02). 6 The APA is codified at 5 U.S.C. 551-559, 701-706, 1305, 3105, 3344, 4301(2)(E), 5335(a)(B), 5372, and 7521. 7 William F. Fox, Jr., in Issue 3 (2001) of this newsletter; James T. O'Reilly, Burying Caesar:
Replacement of the Veterans Appeals Process Is Needed to Provide Fairness to Claimants, 53

Admin. L. Rev. 223, 225, 243-247 (2001).

8 O'Reilly, supra at 243, citing, Charles L. Cragin, The Impact of the Judicial Review on the Department of Veterans Affairs Claims Adjudication Process: The Changing Role of the Board of Veterans' Appeals, 46 Me. L. Rev. 23, 40

(1994).
9 38 U.S.C. 7101.

U.S.C. 7101A(a). U.S.C. 7101A(c)-(g). 12 38 U.S.C. 7101A(c)-(e). 13 Fifth Judicial Conference, BVA's Role in Cases before the Court, moderated by Jeffrey N. Luthi, 12 Vet. App. 75, 76-84 (September 1998). 14 38 U.S.C. 7101A(e)(2). 15 38 C.F.R. 19.3, 19.10(c). 16 38 U.S.C. 7101(c)(1). 17 38 C.F.R. 20.1304(b)-(c). 18 38 U.S.C. 5904(c). 19 Fox, at 37-42. 20 38 U.S.C. 7104(d).
11 38

10 38

21 38

U.S.C. 7104(c).

END OF EXHIBIT

Social Security Fraud

In This Issue
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Novem ber 2004 Volume 52 Number 6
United States Department of Justice Executive Office for United States Attorneys Office of Legal Education Washington, DC 20535 Mary Beth Buchanan Director Contributors opinions and statements should not be considered an endorsement by EOUSA for any policy, program, or service. The United States Attorneys Bulletin is published pursuant to 28 CFR 0.22(b). The United States Attorneys Bulletin is published bi-monthly by the Executive Office for United States Attorneys, Office of Legal Education, 1620 Pendleton Street, Columbia, South Carolina 29201. Periodical postage paid at Washington, D.C. Postmaster: Send address changes to Editor, United States Attorneys Bulletin, Office of Legal Education, 1620 Pendleton Street, Columbia, South Carolina 29201. Managing Editor Jim Donovan Technical Editor Nancy Bowman Law Clerk Carolyn Perozzi Internet Address www.usdoj.gov/usao/ reading_room/foiamanuals. html Send article submissions to Managing Editor, United States Atto rneys Bulletin, National Advocacy Center, Office of Legal Educat ion, 1620 Pendleton Street, Columbia, SC 29201.

Prosecuting Title II Cases: Protecting The Social Security Trust Funds from Fraud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 By John K. Webb Overview of the Felony Frau d Provisions of the Social Security Act . . . . 15 By J onathan Morse Prosecuting Supplem ental Security Income (SSI) Fraud: Punishing Abusers of the Nation's Federal Welfare Program . . . . . . . . . . . . . . . . . . . . . . . . . . 20 By John K. Webb Prosecuting Social Security Recipients for False Endorsem ent of Treasury Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 By Judith Rin gle Prosecuting Representative Payee Fraud: Protecting the Needy from Predators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 By John K. Webb

Introduction
The Social Security Administration (SSA) gained its independence from the Department of Health and Human Services (DHH S) in 1995 and is headed by an Inspector General (IG), who serves at the pleasure of the President. The mission of SSA, Office of the Inspector General (OIG), is to improve SSA programs and operations and protect them from fraud, waste, and abuse by conducting independent and objective audits, evaluations, and investigations. In carrying out its mandate, SSA/OIG provides timely, useful, and reliable information and advice to SSA officials, Congress, and the public. The articles in this issue of the United States Attorneys' Bulletin were contributed by the staff of the SSA/OIG's Office of the Chief Counsel (OCCIG). OCCIG's primary duty is to provide independent legal advice and counsel to the IG on various matters, including statutes, regulations, legislation, and p olicy directives. OCC IG also advises the IG on investigative procedures and techniques, as well as legal implications and conclusions to be drawn from audit and investigative material. The Chief Counsel heads OCCIG. The office also includes a Deputy Chief Cou nsel, a supervisory attorney, several staff attorneys, law clerks/paralegals, and an administrative assistant. The majority of the staff is located at SSA headquarters in Baltimore, Maryland; however, there are several attorneys in various field offices. In addition to its advisory duties, OCCIG also plays an advocacy role in furtherance of the O IG's mission. OC CIG administers a civil monetary penalty program, which seeks administrative remedies against individuals, as well as corporations, who violate sections 1129 and/or 1140 of the Social Security Act, Pub. L. No. 74-271, 49 Stat. 620 (1935). M oreover, attorneys within OCCIG serve as Special Assistant United States Attorneys in several districts. OCCIG attorneys litigate matters in administrative forums, including the Merit Systems Protection Board and the D HH S's Departmental A ppeals Board. Additionally, OCC IG operates an attorney-on-call program. Individuals from other agencies or organizations may call or e-mail the duty attorney to obtain guidance, assistance, and other information within SSA/OIG's purview. The attorney-on-call frequently assists Assistant United States Attorneys with matters involving fraud, waste, or abuse pertaining to SSA and its programs. This assistance includes, but is not limited to, the development of language necessary for the prosecution of violations of Title 42 of the United States Code, the development of cases involving identity theft or Social Security number misuse under 18 U.S.C. 1028 and 1029, and research into issues particular to SSA fraud. The OCCIG attorney-on-call may be reached by calling (410) 965-6211, Mon day through Friday from 8:30 a.m. to 5:00 p.m. EST. For more information on SSA/OIG, please visit the website at http://www.ssa.gov/ oig/index.htm.

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Prosecuting Title II Cases: Protecting the Social Security Trust Funds from Fraud
John K. Webb Special Assistant United States Attorney Central District of California I. Introduction
The Social Security Act of 1935 (the Act), enacted during the G reat D epression, is generally viewed as one of the most important legislative accom plishm ents in U nited States history. ( See 42 U.S.C. 301-1399). The Act established a program to provide lifetime payments to retired workers beginning at age sixty-five, set up the federal system of unemployment insurance, and authorized federal grants to the states for various purposes. The initial legislation of the 1935 Act laid the foundation for the Social Security programs used today by millions of Americans. The Act has been amended many times during the intervening years, but its original purpose remains the same: "to ameliorate the rigors of life, the tragic consequences of old age, disability, loss of earnings power, and dependency on private or public charity." See Dvorak v. Celebrezze , 345 F.2d 894 , 897 (10th Cir. 1965). Since 1935, Social Security benefits have increased, and the program has been broadened to include benefits for workers' spouses and minor children, for the survivors of deceased workers, and for disabled workers. These programs are known as Title II benefits programs and are administered by the Act. United States Treasury, while the Federal Disability Insurance (DI) Trust Fund, another separate account in the United States Treasury, was established on August 1, 1956. All the financial operations of the OASDI and DI programs are handled through these respective fund s. The primary receipts of the two funds are amounts appropriated to each of them, under permanent authority, on the basis of contributions payable by workers, their employers, and individuals with self-employment income, in work covered by the O AS DI program. All employees, and their employers, in covered employment, are required to pay contributions with respect to their wages. All self-employed persons are required to pay contributions with respect to their covered net earnings from self-employm ent. G enerally speaking, an individual's contributions, or taxes, are computed on wages or net earnings from self-employment, or both wages and net self-employment earnings combined, up to a specified maximum annual amount. The contributions are determined first on the wages and then on any net self-employment earnings, such that the total does not exceed the annual maximum am ount. The mon thly benefit amount to which an individual (or his spouse and children) may become entitled under the OA SD I program is based on the individual's taxable earnings during his lifetime. According to the 2002 OASDI Trustees R eport (available at http://www.ssa.gov/ OAC T/TR/TR02/), about 154 million persons worked in OA SDI-covered employment or self-emp loyment in 2002. A pproximately n inetysix out of one hundred workers in paid employment and self-employment remain covered or eligible for coverage, and, as of December 31, 2002, about ninety-two percent of the population aged sixty-five and over were receiving benefits. In addition, about ninety-seven percent of persons aged twenty to forty-nine who worked in covered employm ent in 2002 acquired survivorsh ip protection for their children under age eighteen
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II. The Title II benefits programsOldAge, Survivors, and Disability Insurance (OASDI).
Du ring 2003 SSA m ade Title II benefits payments to 32,347,974 retired workers and dependents; 6,875,054 survivors; and 7,221,268 disabled workers and dependents. See 2003 OA SD I Trustees Report, available at http://www.ssa.gov/OAC T/TR/TR03/. The Federal OAS DI Trust Fund w as established on January 1, 1940, as a separate account in the
2

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(and surviving spouses caring for children under age sixteen). About ninety percent of persons aged twenty-one to sixty-four who worked in covered employment in 2002 are eligible to receive monthly cash benefits if they suffer a severe and prolonged disability.

A. Disability Insurance Benefits Program

The object of the Disability Insurance Benefits Program (DIB) is to replace part of the earnings lost because of a physical or mental impairment. M onth ly benefits are paid to eligible disabled persons and their eligible auxiliary beneficiaries throughout their period of disability. There are no restrictions on the use of benefits received by beneficiaries. Disability benefits cannot be paid to a person confined in a penal institution because of a felony. Month ly benefits may be paid to: disabled workers under age sixty-five and their families; unmarried persons disabled before age twenty-two who continue to be disabled; and disabled widows or certain surviving divorced spouses ages fifty to fifty-nine who were disabled at the time of the worker's death or became disabled within a specified period thereafter.

who meets the earnings requirement of being fully insured. Monthly spouse's and child's insurance benefits are also payable on the earnings record of an individ ual entitled to retirem ent benefits, if they are eligible auxiliaries. Social Security benefits are based upon the worker's earnings as established by the Social Security Adm inistration (SSA ). For this reason, the SSA maintains a complete record of the earnings of each worker covered by Social Security. These earnings are used to determine entitlement to retirement benefits and the m onthly amount of the benefits.

C. Survivor's Insurance Benefits Program

The Survivor's Insurance Benefits Program (SIB) pays m onth ly cash benefits to eligible dependents of deceased workers. Survivors eligible for monthly cash benefits include widows and widowers, and surviving divorced wives or husbands who were married to the deceased worker for at least ten years. A ge requ irements are lower for disabled survivors and survivors who have dependents of the insu red w orker in their custody.

III. Impact of fraud on the SSA benefits programs

The Title II programs have suffered significant episodes of fraud, and the costs to the Social Security trust funds can no longer be ignored. One who wrongfully applies for and/or receives benefits paym ents under any of the Title II programs may be subject to crim inal liability under 42 U .S.C . 408(a)(1)-(8), which sets forth penalties for felony fraud violations un der Title II of the Act. The Social Security felony fraud statute can be used separately or in concert with general federal criminal statutes found in Title 18, to prosecute fraud in benefits programs. A key risk factor in T itle II programs are individ uals who feign or exaggerate symptoms to become eligible for disability benefits, and those who fail to report changes in resources or other circumstances that w ould make a recipient of T itle II benefits ineligible to continue to receive paym ents. Eligibility for the Title II programs is often complex and difficu lt to verify, and SS A's ability to properly determine a recipient's initial and continued eligibility, an d the correct month ly benefit due that recipient, is directly dependent upon SSA's ongoing access to accurate and current information regarding the recipient.
3

Generally, to have disability protection for one's self and family, it is necessary to have Social Security credits for five years out of a ten year period ending when the disab ility begins. W orkers disabled at age forty-three or older need credit for more than five years of work. A person disabled before age thirty-one may require as few as one and a half years of credited earnings. Medical evidence of the disabling condition is required, and medical recovery and/or work activity are events that affect entitlement or continued entitlement to disability benefits.

B. Retirement Insurance Benefits Program

The objective of the Retirement Insurance Benefits Program (RIB) is to replace part of the earnings lost because of retirement. M onth ly benefits are paid to eligible retired workers and their eligible dependents. There are no restrictions on the use of benefits by a beneficiary. M onth ly RIB (also called old-age insurance benefits) may be payable to an individual age sixty-two or over
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As is evident, even the slightest error or fraud in the overall process can result in millions of dollars in overpayments or underpayments of Social Security benefits. It is therefore imperative that fraud in the Title II programs be identified and, wherever possible, prevented. The other alternative, after the fraud has b een committed, is to prosecute and recover benefits overpaymen ts from those who perpetrate the fraud. To that effect, the Congress and the SSA have collaborated to make fraud again st the Title II program s punishable as a felony, resulting in penalties of imprisonment up to five years and a fine of as m uch as $250,000. Between October 1, 2002 and March 31, 2003, the Office of the Inspector General for the Social Security Administration (SSA/OIG) received 51,311 fraud allegations from a variety of sources, includ ing private citizens (23,951), anonymous tips (8,782), SSA employees (7,402), law enforcement (10,120), public agencies (323 ), and SSA benefits recipients (726). See SSA/OIG 200 3 Semiannual Report to Congress, available at http://www.ssa.gov/oig. At the same time, SSA/OIG opened 9,170 potential fraud cases and investigated and closed approximately 9,389 cases nationwide. During the same period, investigations by special agents of SSA /OIG culm inated in 2,677 arrests and indictments involving Social Security fraud, which resulted in 1,008 criminal convictions. The SSA statistics suggest an alarming increase in fraudulent claims that threaten the integrity of the Social Security Trust Funds and block access by need y applicants with legitimate claims for benefits. In man y cases, benefits paid to needy applicants serve as a lifeline that means the difference between survival and death. As disturbing as the statistics are, they represent only the identified instances of overpayments in the SSA programs. They do not represent undetected overpayments stemming from fraud, waste, and abuse. If the current trends continue, thousands more potential SSA fraud cases will focus increased attention on the felony provisions of the Act and result in scores of federal and/or state indictments and conviction s. The opportunity for fraud is enhanced because SSA is an agency that has, historically, made extraordinary efforts to ensu re accessibility to its benefits programs by qualified Americans. According to current estimates by auditors of the SSA, fraud against the various SSA b enefits programs may account for as much as ten percent
4

of all costs to the Social Security Trust Funds. SSA /OIG 2003 Semiannual Report to Congress, available at http://www.ssa.gov/oig/ ADO BEPDF /sar102002032003.pdf. Considering the volume and amount of payments SSA makes each month, even the smallest percentage of fraud, waste, and abuse can result in the loss of millions of dollars. It is not surprising, then, that fraud perpetrated on Social Security benefits programs has increasingly attracted national attention.

IV. Statutory authority

The felony fraud provision s of th e Title II programs are found in 42 U.S.C. 408(a)(1)-(8) of the Act. M ost fraud involving the Title II benefits programs is the result of deliberate deception, and arises when an ap plicant falsifies a document or record offered as proof of disability, or misrep resents material facts, such as paternity, on an application for benefits. Fraud can also be the result of omission when a beneficiary fails to report a change in circumstance, such as marriage, a new source of income, incarceration, removal from custodial care, or failure to report the death of a parent or spouse, while continuing to spend checks or direct deposits by SSA. The following are rep resentative of violations that could result in criminal prosecution for Social Security fraud: furnishing false information of identity in connection with the establishment and maintenance of Social Security records, or with the intent to gain information as to the date of birth , employm ent, w ages, or benefits of any person; forging or falsifying SSA documents; conspiring to obtain or allow a false, fictitious, or fraudulent claim; using a Social Security Number (SSN) obtained on the basis of false information or falsely using the SSN of another person, for the purpose of obtaining or increasing a payment under Social Security or any other federally funded program, or for any other purpose; altering, buying, selling, or counterfeiting a Social Security card; disclosing, using, or compelling the disclosure of the SSN of any person for unauthorized purposes;

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making or causing to be made a false statement or representation of a material fact for use in determining rights to Social Security benefits, Medicare, Supplemental Security Income, or Black Lung benefits; making or causing to be made any false statement or representation of a material fact in any application for any payment or for a disability determination under the Social Security Act; making or causing to be made any false statement or representation as to whether wages were paid or received, the amount of such wages, the period during which wages were paid or received, or the person to whom such wages were paid; making or causing to be made any false statement or representation as to whether net earnings from self-employment were received, the amount of such earnings, the period during which such earnings were received, or the person who received them; concealing or failing to report any event affectin g the initial or continued right to payment received, or to be received by a person individually or on behalf of another; converting all or any part of a payment received on beh alf of a beneficiary to a use other than for the use and benefit of that beneficiary; falsely representing oneself to be an employee of the U.S . Government; accessing SSA computer records without authorization; disclosing unauthorized information from the SSA 's systems of records; or receiving or soliciting a bribe, illegal gratuity, or contribution to or supplementation of salary for U.S. Government service.

intent is to defraud or deprive someone of something, while the Title 18 criminal provisions usually require only an intent to deceive. For example, simply making a mistake or giving untrue information, without any intent to deceive or mislead, does not constitute the requisite intent for a conviction under Title 18 crimes. U. S. v. Lange , 528 F.2d 1280 (5th Cir. 1976).

V. The Title II criminal fraud provisions: 42 U.S.C. 408(a)(1)-(8)

Title II of the Act, cited as 42 U.S.C. 408(a)(1)-(8), contains the Act's primary criminal provisions and carefully spells out the Act's restraints on fraud by specifying requirements for disclosure of specific events, and identifying facts that affect the right to payment of SSA benefits. Initially enacted as a misdemeanor statute, Congress am ended T itle II of the Act in 1981 to increase the penalty, making Social Security fraud (including SSN misuse) a felon y, punishable by five years in prison and a fine up to $25 0,000. See Pub. L. No. 97-123, 95 Stat. 1659 (198 1 amendments).

A. 42 U.S.C. 408(a)(1)(A)-(C)
The elements required to prove a violation of 408(a)(1)(A)-(C) are: a false statement or representation; used to cause payment of benefits; where no payment is authorized; and whether wages were paid or received or the amount of wages or the period for which they were paid.

See 42 U .S.C. 408(a)(1)(A)-(C). Criminal liability under 42 U.S.C. 408(a)(1) arises if: (i) an individual makes a false statement or representation about income in order to secure a higher benefit; or (ii) an employer or individual makes false statements in reporting wages or earnings to SS A or the IRS. For example, a defendant was incarcerated at the time he asked his friend to put his son on the payroll of the friend's company as a "no-show" employee so that his son would have health insurance. The friend paid defendant's son $500 per week, issued a $340 payroll check and withheld $160 in federal and state taxes in the son's name. Defendant and his son repaid the friend $500 each week in cash. The
5

The major difference between violations of federal criminal statutes under Title 18 and those in the Social Security Act (Title 42) is the criminal intent required. See U. S. v. Lichenstein , 610 F.2d 1272, 1277 (5th Cir. 1980) ("The criminal intent required for a violation of the federal criminal provision is merely the intent to deceive or mislead, not an intent to defraud or deprive someone of something by means of that deceit."). In most Title 42 crimes, the relevant
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son never worked for the friend's company, and the friend kept the repaid cash without reporting it as income, while the friend's company claimed a deduction for the son's wages on its federal and state tax returns and made wage and earnings reports to SSA and the IRS. As a result of his job with the friend's company, and the false statements as to the son's wage and earnings made by the friend and his company, the son later applied for and qualified for $7,700 in SSA benefits. United States v. Mauro , 80 F.3d 73 (2d Cir. 19 96). See also United States v. Kaczowski, 882 F. Supp. 304 (W.D.N.Y. 1994) (defendant was placed in a "no-show" job on the payroll of a game room in order to laund er gambling receipts).

See 42 U .S.C. 408(a)(3). Criminal liability under 42 U.S.C. 408(a)(3) arises if an individual makes or causes to be made a false statement, or misrepresents a material fact, used in determining entitlement to benefits. For example, a defendant, when completing questions about his work activities, falsely stated on an SSA form that he had not worked for four years, and was disabled and unable to perform work. In truth, the defendant was working at the time he completed the SSA form and had been employed full time for several years as a computer worker by the Internal Revenue Service. United States v. Codrington , No. CR-03-458-GAF (C.D. Cal. Jan. 29, 2003 ).

B. 42 U.S.C. 408(a)(2)
The elements required to prove a violation of 408(a)(2) are: defendant makes or causes to be made a false statement or representation; of a material fact; in any application for any payment or for a disability determination.

D. 42 U.S.C. 408(a)(4)
The elements required to prove a violation of 408(a)(4) are: defendant received Social Security benefits on behalf of another person; defendant had knowledge of an event affectin g the other person's continued right to Social Security payments; defendant know ingly concealed or failed to disclose this event to the Social Security Administration; and defendant concealed or failed to disclose this event to the Social Security Administration with the intent to fraudulently secure payment of Social Security Income benefits in an amount greater than was due the other person or when no payment to the other person was authorized.

See 42 U .S.C. 408(a)(2). Criminal liability under 42 U.S.C. 408(a)(2) arises if an individual makes or causes to be made a false statement, or misrepresents a material fact, on any application for benefits under any SSA Title II program. For example, a defendant made false statements in an application for payment of SSA Survivor's Benefits by stating that she had never before filed for benefits under any other name or SSN and had never used any SSN or name other than her own. In fact, the defendant had used numerous false SSN s on various W -4 forms from several different employers. See United States v. Kienenberger, 168 F.3d 496 (8th Cir. 19 98).

See 42 U.S .C. 408(a)(4); United States v. Baum gardner , 85 F.3d 1305 , 1310-11 (8th C ir. 199 6). Criminal liability under 42 U.S.C. 408(a)(4) arises if an individual knowingly conceals a fact to secure a benefit to which he or she is not entitled. For example, a defendant, when completing questions about his work activities, falsely stated on an SSA form that he had not worked for four years, and was disabled and unable to work. In fact, defendant was working at the time he completed the SSA form and had been employed full time for several years by the Internal Revenue Service. United States v. Codrington , No. CR-03-458-GAF (C.D. Cal. Jan. 29, 2003 ).
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C. 42 U.S.C. 408(a)(3)
The elements required to prove a violation of 408(a)(3) are: defendant makes or causes to be made any false statement or representation; of a material fact; for use by the Social Security Administration in determining rights to payment of benefits.

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With respect to the first element, courts have construed the term "event" broadly, to include essentially anything that would affect the right to payment. United States v. Baumgardner , 85 F.3d 130 5, 1310-11 (1996). See also United States v. Huckaby, 698 F.2d 915 (8th Cir. 1982). The second element is self-evident and straightforward, requiring that the defendant must know of the event affecting his right to payment and knowingly conceal it. The third element requires that the concealment must have been "with an intent fraud ulently to secure paymen t...in an amount greater than was due." 42 U.S.C. 408(a)(4). In United States v. Cormier, 639 F.2d 1177 (8th Cir. 1981), the prosecution showed that the defendant concealed or failed to disclose her employm ent and earnings to the Social Security Administration, with the "intent to secure fraudulently unauthorized benefits." The prosecution offered evidence showing that the defendant knew she w as legally obligated to disclose such information and knew she was required to file annual income reports because her original application for benefits provided notice of the reporting requirement. Further, defendant knew of the reporting requirement because her job as a Social Security service representative required her to inform other applicants and beneficiaries of their continuing obligation to do so. Id . at 1181. In the case of United States v. Phillips, 600 F.2d 535 , 536 (5th Cir. 1979), the court defined the government's burden in proving "fraudulent intent" under 408(a)(4). T he court stated that: First, the government must show that the defendant knew that he was legally obligated to disclose certain information. Second, the government must prove that the defendant knew that by withholding the information he would receive greater payments than he was entitled to. In other words, a defendant is not guilty under 408(d) unless he is aware both that he is deceiving the government and that the government will pay out more money becau se of his deception. Theft of public funds by the fraudulent receipt of Social Security benefits on a continual basis may be considered relevant conduct under the Sentencing Guidelines when determining the base offense level in a case where the conduct is part of the same course of conduct or common scheme or
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plan as the offense of conviction. See United States v. Silkowski , 32 F.3d 682 (2d Cir. 1994). In Silkowski, the court found that when a defendant engages in a clearly identifiable and repetitive "behavior pattern" of a specified criminal activity, such as continual illegal receipt and conversion of S ocial Security benefits, a district court may rely on such conduct as "relevant" under the federal Sentencing Guidelines, regardless of whether that conduct was charged as part of the offense of conviction. Id.

E. 42 U.S.C. 408(a)(5)
The elements required to prove a violation of 408(a)(5) are: the defendant knowingly and willfully converts; a benefit payment, or any part of a benefit paym ent; accepted on behalf of another; to an unauthorized use.

See 42 U .S.C. 408(a)(5). Criminal liability under 42 U.S.C. 408(a)(5) arises if an individ ual know ingly and willfully converts to an unauthorized use a benefit that he or she has accepted as payee on an other's behalf. For example, a criminal violation occurs if a defendant applies (a formal application to become Representative Payee is required by SSA) to become Representative Payee for the use and benefit of an other (spouse, parent, grandparent, child, friend), and, having received payment(s) of a benefit from SSA on behalf of another, knowingly and willfully converts the payment(s) to his own use, rather than for the use and benefit of the intended beneficiary. A common violation occurs wh en a Representative Payee intentionally conceals the death of another in order to continue to receive and spend the benefits payments made by SSA to the Representative Payee.

F. 42 U.S.C. 408(a)(6)
The elements required to prove a violation of 408(a)(6) are: defendant w illfully, knowingly, and with intent to deceive as to his true identity or the identity of another person;
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furnishes, or causes to be furnished , false information to SSA; with respect to any information used by SSA to establish or maintain records.

approach. Companion charges for prosecution of corporations caught violating 42 U.S.C. 408(a)(6) usually include 18 U.S.C. 1001 (false statement on I-9) and 1546 (immigration fraud).

See 42 U .S.C. 408(a)(6). Criminal liability under 42 U.S.C. 408(a)(6) arises when a person willfully, knowingly, and with the intent to deceive the SSA as to his or her true identity, or the true identity of any other person, furnishes or causes another to furnish false information to the SSA that SS A uses to establish and maintain earnings records. A typical violation of 408(a)(6) occurs when an individual makes false statements on an application for a new SSN (SSA F orm SS-5) for the purpose of obtaining a second SS N to create a false identity. The most comm on false statem ent occu rs when a defendant, in response to the following question on the SS-5: "Has applicant or anyone acting on his/her behalf ever filed for or received a Social Security number card before?" falsely answers "no," when, in fact, the defendant knows his answer is false and it is his intent to deceive the Commissioner of Social Security as to his true identity. The defendant can be charged with a violation of 408(a)(6) for the false statement on the SS-5 as well as any subsequent use of the second SS N. A person may also be subject to criminal penalties under 408(a)(6) for furnishing false information in conn ection with earnings records. See 20 C.F.R. 422.108. Criminal liability can also arise under 42 U.S.C. 40 8(a)(6) when an employer, knowingly, and with intent to deceive as to the identity of another person (such as an employee), furnishes, or causes another to furnish on the employer's behalf, false information to the SSA that SS A u ses to establish or maintain its records. This usually occurs when an employer, who knows that an em ployee is working while using a false SSN and/or identity, makes false statements in wage and earnings reports to SSA and the IRS as to such wages and earnings or identity. This charge is especially applicable to companies who frequently hire individuals that the company suspects have provided false documents in order to work. Prosecution of vulnerable employees for trying to make a living in order to survive is unappealing for a number of reasons. How ever, prosecution of offenders whose corporate hiring policies are the source of the problem is a more cost-effective and practical
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G. 42 U.S.C. 408(a)(7)(A)-(C)
The felony provisions of 42 U.S.C. 408(a)(7)(A)-(C), which deal with the misuse of an SSN, are particularly effective in charging cases involving identity theft or where an individual has tried to manipulate the identification systems currently in place, or where an individual has entered the country illegally. In many cases, recipients of Social Security benefits under one Title II program will be caught using a false identity an d SSN to apply for, and collect, benefits under a second (or the same) Title II benefit program. This has been a common technique used by criminal travelers, who use multiple identities to apply for, and collect, benefits from SSA offices in different regions of the country. The elements of proof for each subsection of 408(a)(7) are more flexible than those required by 18 U.S.C. 1028, a better known iden tity theft statute, that also contains subsections dealing with the misuse of an S SN. What follows is a description of each of the three subsections of 408(a)(7), including a breakdown of the elements necessary to prove a charge under each, and a brief suggestion of when and how each subsection should be charged. 42 U.S.C. 408(a)(7)(A) The elements required to prove a violation of 408(a)(7)(A) are: defendant, with intent to deceive; willfully and knowing uses a Social Security account number; assigned to him by the Commissioner of SSA; based on false information furnished by defendant or another person to the Com missioner of Social Security.

See 42 U .S.C. 408(a)(7)(A). Any fraudulent use of an SSN, whether made up by the offender or obtained on the basis of false information supplied to SS A, is actionable and constitutes a felony for purposes of 408(a)(7)(A). For example, a subject in the
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United States on a tourist visa secures a nonwork SSN using his French passport. The subject then uses an alias to file a bogus application for asylum, resulting in United States Citizenship and Immigration Services (USCIS) approval and issuance of a green card and alien registration number. The subject then uses his new name and illegally procured USC IS documents to apply for a second SS N, thus com pleting the creation of a new identity. The subject then uses the second SSN to secure credit cards, open bank accounts, attend flight training, and make applications for employment as a pilot. The subject's use of the SSN is actionable because he used false and fraudulent documents (deceptively procured from the USCIS) to deceive SSA into issuing him a new SSN, and he may be charged with a felony und er 40 8(a)(7)(A). See United States v. Pryor, 32 F.3d 1192, 1194 (7th Cir. 1994) (defendant acted "willfu lly, knowingly, and with intent to deceive," in illegally using an SSN obtained on the basis of false inform ation). 42 U.S.C. 408(a)(7)(B) The elements required to prove a violation of 408(a)(7)(A) are: false representation of a Social Security account number; with intent to deceive; for any pu rpose.

It is typically charged whenever a subject has misrepresented an SSN to open a bank accoun t; apply for a credit card; secure credit for a cell phone; rent or lease an apartment or car; apply for employment; or enroll in flight training. The charging standard, "for any purpose," is broad and self-explanatory, and any false representation of an SSN , with an intent to deceive, is actionable conduct that may be charged as a felony under 408(a)(7)(B). See United States v. Silva-Chavez , 888 F.2d 1481 (5th Cir. 1989). The legislative history of 408(a)(7)(B) demonstrates that Congress intended to extend criminal liability for false use of an SSN beyond the false use of a number to obtain or increase benefits under the Social Security A ct, of which it is part. See S. Rep. No. 938 at 490 (1976), reprinted in 1976 U.S.C.C.A.N. 2897, 4030, 4194 ("The Senate amendm ent...makes a misdemeanor the willful, knowing, and deceitful use of a social security number for any purpose."). In 1981 Congress amended the section, changing the offense from a misdemeanor to a felony and adding the language "or for the purpose of obtaining anything of value from any person" before "or for any other purpose." See Pub. L. No. 97-123, 95 Stat. 1659, 1663-64 (1981). While the House Conference Report accompanying the amendment offers no explanation of the reasons for the change, H.R. Conf. Rep. No. 409, at 15-16 (198 1), reprinted in 1981 U.S.C.C.A.N. 2681, 2687-88, the text of the amendm ent makes clear Congress' intent both to punish a broader range of acts and to impose a stiffer penalty. See Un ited States v. Darrell, 828 F.2d 644 (10th Cir. 198 7). Direct evidence is not always necessary in order to prove that a defendant intended to use a Social Security card or number for deceptive purposes. M ere possession of a Social Security card or number that does not belong to a defendant is sometimes sufficient to sup port a finding that the defendant intended to deceive. United States v. Charles, 949 F. Su pp. 365 (D .V.I. 1996). In Charles , the government w as un able to produce direct evidence that the defendant had actually applied for a driver's license using a false SSN , but concluded that the jury could infer that the defendant received the S ocial Security card through false representations when the government's evidence showed that: (1) the Police Department Licensing Section had printed defendant's license; and (2) generally, in order to

See United States v. Means, 133 F.3d 444, 447 (6th Cir. 1998) (setting forth the elements for prosecution of a case under 42 U.S.C. 408(a)(7)(B)). See also United States v. McC ormick , 72 F.3d 1404 , 1406 (9th Cir. 1995). The majority of jurisdictions apply the Means standard as set forth above. However, a few jurisdictions break down the language of 408(a)(7)(B) to include a fourth element: for any purpose; with intent to deceive; represented a particular S ocial Security account nu mber to be his; which representation is false.

See United States v. O'Brien, 878 F.2d 1546 (1st Cir. 19 89). Subsection (B) is the most commonly charged subsection of 408(a)(7) because of its broad application and straightforward elemen ts of proof.
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obtain such a license, an applicant must give an SSN to the licensing agent. However, m ere possession of false identity documents, including a false SSN, might not always be enough to convict. Some courts have held that the term "represent" connotes a positive action, not merely passive possession, and have thus reasoned that Congress, by using the term "represent," meant to proscribe the "use," not merely the "possession," of a false SSN. United States v. McKnight, 17 F.3d 1139, 1144-45 (8th Cir. 1994). However, the concurring opinions of two McKnight panel members prove that this is not a hard and fast rule: "W e write separately to make explicit that possession of an identification card bearing a false social security number can, in some instances, provide a sufficient predicate for a jury to properly infer that a defend ant falsely represented a social security number in violation of 42 U.S.C. 408(a)(7)(B)." Id. at 1146. In Un ited States v. Teitloff , 55 F.3d 391, 394 (8th Cir. 1995 ), the court rejected the defend ant's contention that he did not technically "use" the SSN because the DMV comp uter system automatically provided that information when he supplied the other person's identification docum ents. A defendant may be found to have acted willfully, knowingly, and with intent to deceive, even if the defendant did not intend to deceive federal officials when he presented them with documents containing a false SSN. In U.S. v. Pryor, 32 F.3d 1192 (7th Cir. 1994), the defendant's license had been suspended, and he was found to be carrying false documents which he acknowledged that he planned to present if pulled over for a traffic violation. The N inth Circuit has held that an alien's use of a false SSN to further otherwise legal conduct is not a crime of "moral turpitude." Beltran-Tirado v. Immigration and Naturalization Serv., 213 F.3d 1179, 1184 (9th Cir. 2000). The significance of this decision lies in the impact such a conviction would have on the illegal alien's eligibility for inclusion on the Immigration and Nationality Act registry. See 8 U.S.C. 1259. The registry statute was originally enacted by Congress in 1929 as a means to regularize the status of long-time illegal aliens residing in the Un ited States, an d has been updated periodically since. Und er current registry provisions, conviction for a crim e of moral turpitude w ould preclude an alien from eligibility because he
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would not be considered "of good moral character." Id. In Beltran-Tirado , defendant lived under an assumed identity, using the name and SSN of the victim to marry twice and obtain employment, a driver's license, credit cards, and a Housing and Urban Developm ent loan. The defend ant's earnings attracted the interest of the IRS, resulting in her arrest and conviction under 42 U.S.C. 408(a)(7)(B) and 18 U.S.C. 1546(b)(3). The INS moved to deport her, but the Ninth Circuit intervened to interpret the legislative history of 42 U.S.C. 40 8 and carve out an exception to a conviction for a crime of moral turpitude by allowing the use of a false SSN to further "otherwise legal behavior." The Beltran-Tirado case appears consistent with an earlier decision by the Ninth Circuit in which the court concluded that the crime of knowingly and willfully making any false, fictitious, or fraudulent statements or representations to an agency of the United States is not a crime of moral turpitude because a jury could convict if it found that the defendant had knowingly, but without evil intent, made a false but not fraudulent statement. Hirsch v. INS , 308 F.2d 562, 567 (9th C ir. 1962). Another California federal court, citing Beltran-Tirado , held that the sale of false or counterfeit SSNs is a crime that involves moral turpitud e. Souza v. Ashcroft , No. C00-4246MMC, 2001 WL 823816 (N.D. Cal. July 16, 2001). The court distinguished between those who sell, rather than use, false or counterfeit Social Security cards ("persons convicted of the crime of selling false or counterfeit Social Security cards have, like persons convicted of the analogous crime of selling counterfeit green cards, committed a crime of moral turpitud e") Id. at *3, and stated that Congress, in amending 42 U.S.C. 408, specifically excluded from the exem ption those who sell, rather than use, false or cou nterfeit Social Security cards. Th e reason for this distinction is apparent. Selling false alien registry docum ents (green cards), as well as selling false or counterfeit Social Security cards, inherently involves a deliberate deception of the government and an impairment of its lawful functions. When an individual makes multiple false representations by misrepresenting an SSN on multiple credit card applications, bank accounts,
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or federal documents relating to employment (I-9, W-4 form s), that person is charged with a separate offense for each use or representation. Each of the separate offenses is supportable by a different set of predicate facts and is actionable under 408(a)(7)(B). In addition, each use or representation on a federal form is actionable as a false statement under 18 U.S.C. 1001 and can be charged as a separate offense, also supportable by a different set of predicate facts. While charging multiple counts might not be desirable, doing so when separate predicate facts exist would not run afoul of the rule against mu ltiplicity that prohibits the charging of a single offense in several counts. United States v. Castaneda , 9 F.3d 761, 765 (9th Cir. 1993) (holding that a defend ant m ay properly be charged with comm itting the same offense more than once as long as each count depends on a different set of predicate facts). See also United States v. Hurt , 795 F.2d 765, 774-75 (9th Cir. 19 86). It is not necessary that the false use or representation of an SSN have a detrimental effect in some way on the government to be actionable. See United States v. Holland, 880 F.2d 1091 (9th Cir. 1989). Any use of a false SSN on nonfederal documents is still actionable un der 408(a)(7)(B). For example, the subject in the case study used his falsely ob tained SSN when completing multiple applications seeking employment as a pilot, and in applying for taxi permits with airport cab companies. Even though the airline and cab company employment applications are not federal documents, the subject can still be charged under 408(a)(7)(B). Further, it is not necessary to prove that the defendant used a false SSN for payment, gain, or pecuniary value. United States v. Silva-Chavez , 888 F.2d 1481 (5th Cir. 1989). In addition, the Fourth Circuit has held that 408(g)(2) applies to private, purely commercial transactions. See United States v. Bales, 813 F.2d 1289, 1297 (4th Cir. 1987); United States v. Da rrell , 828 F.2d 644 (10th Cir. 1987) (affirming convictions for using a false SSN in seeking bank loans). See also U nited States v. Rosen berg , 806 F.2d 1169, 1171-72 & n. 1, 1180 (3d Cir.1986) (using a false SSN in a commercial transaction). The use or nonuse of a defendant's SSN on loan applications and tax returns is not protected by the First Amendment. See United States v. Bales , 813 F.2d 1289 (4th Cir. 1987). Similarly, a defendant's deceitful use of another person's SSN to open a bank account was within the "any other
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purpose" clause of a statute prohibiting deceptive use of an SSN for any purpose. United States v. Barel , 939 F.2d 26, 28 (3d Cir. 1991) ("The Social Security felony fraud statute applies to the intentional use of a false Social Security number 'for any purpose' when a defendant uses a false Social Security number to open bank accounts, even absent proof of pecuniary gain to defendant."). False representation of a fake, nonexistent, SSN may constitute the offense of false pretenses. See United States v. Bales, 813 F.2d 1289 (4th Cir. 1987). According to 18 U.S.C. 1028(d)(1), an "identification document" is "a document made or issued by or under the authority of the United States Government...which, when completed with information concerning a particular individual, is of a type intended or commonly accepted for the purpose of identification of individuals." T he H ouse R eport accompanying what became 102 8 demonstrates that the definition includes not only "identification documents, such as driver's licenses, which are widely accepted for a variety of identification purposes," but also those "'commonly accepted' in certain circles for identification purposes, such as identification cards issued by state universities and federal government identification cards." H.R. Rep. No. 802, at 9 (1982), reprinted in 1982 U.S.C.C.A .N. 3519, 3527. The House Report also notes that identification documents "normally will include such identifying elements as an individual's name, address, date, or place of birth, physical characteristics, photograph, fingerprints, employer, or any unique numb er assigned to an individual by any federal or state government entity." Id. Two published circuit court decisions, both by the Fourth Circuit, have applied the definition of "identification documents" under 18 U.S.C. 1028, and they involved Social Security cards and Form I-94 Arrival-Departure Records, which the courts concluded were "identification documents" within the meaning of the statute. See United States v. Pahlavani, 802 F.2d 1505 (4th Cir.1986) (I- 94 forms). In United States v. Quinteros, 769 F.2d 968 (4th C ir. 1985), the court relied on testimony that Social Security cards were "commonly accepted" as identification documents. An employee of the Social Security Adm inistration testified that the Administration often issued cards for older persons to use as identification for cashing checks. She also

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testified that because the cards were so often used for identification, the government removed a notice from the back of the card that stated "Not for Identification Purp oses." In all, the court concluded, there was a "common understanding that Social Security cards are identification documents." Id. at 970. In United States v. McGauley , 279 F.3d 62 (1st C ir. 2002), the defendant was charged with making false statements to the U.S. Postal Service, in violation of 18 U.S.C. 1001; misrepresentation of SSNs, in violation of 42 U.S.C. 40 8(a)(7)(B); mail fraud, in violation of 18 U.S .C. 1341; and money lau ndering, in violation of 18 U.S.C. 1956(a)(1)(B)(i). The court held that convictions for five counts of misrepresentation of SSNs were supported by evidence that the defendant had used false numb ers to open post office boxes under names other than her own, and had refund checks she fraudulently obtained from retail stores sent to those post office boxes. The court also found that the Social Security statute, which proscribes the use, with intent to deceive, of a false SSN, does not require that the SSN be used for the purpose of obtaining a payment to which the user was not entitled. 42 U.S.C. 408 (a)(7)(C) The elements required to prove a violation of 408(a)(7)(C) are: knowingly alters a Social Security card; or counterfeits or possesses a Social Security card with intent to sell or alter it; or buys, or sells a Social Security card.

deceive an honest, sensible, and unsuspecting person of ordinary observation and care dealing with a person supposed to be upright and honest." United States v. Gomes , 969 F.2d 1290, 1293 (1st Cir. 1992) (stating that "the law does not criminalize only masterpieces"). Id. at 1294

H. 42 U.S.C. 408(a)(8)
The elements required to prove a violation of 408(a)(8) are: defendant discloses or uses, or compels the disclosure; of the Social Security number of any person; in violation of the laws of the U nited States.

See 42 U .S.C. 408(a)(8). Criminal liability under 42 U.S.C. 408(a)(8) arises if a person discloses, uses, or compels the disclosure of the SSN of any person in violation of federal law. A typical violation of 408(a)(6) occurs wh en an individ ual w ith access to corporate records, or other sources of information that contain lists of SSN, discloses or uses the SSNs for an illegal activity.

VI. Sample indictments

The following are samples of Indictments of SSA fraud using the Title II felony fraud provision s.

A. 42 U.S.C. 408(a)(2)
COU NT ______ [42 U .S.C. 408(a)(2)] On or about the dates set forth below, in Los Angeles County, within the Central District of California, defendant _______ _____ ___, aka _____________, knowingly and willfully made the following false statements for use in determining defendant's rights to Title II disability benefits:

This subsection is typically charged when a subject has knowingly altered a Social Security card (usually to remove work restrictions from the face of the card), or has manufactured or counterfeited a card or cards for sale on the black market. This section can also be charged when an individual is discovered to have purchased a Social Security card for his own use or for resale. The altered and/or counterfeited cards are then used to secure false identification documents, open bank accounts, apply for credit cards, and to work, including employment in sensitive positions at airports, government facilities, and other locations req uiring security clearances. To pass as a counterfeit, an image must bear such a likeness to the original as "is calculated to
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Count One

Date 01/16/04

Document Statement for Determining Continuing Eligibility for T itle II Disability Paym ents

False Statement Responded "no" to question regarding whether he had received support or money paym ents from any other person or organization since September 1998

determine continued rights to RIB payments for ___ ___ __, her deceased grandmother. Specifically, when completing questions on the SSA Form 623-OCR-SM, defendant ______ concealed her grandmother's death and falsely stated that she had spent $_____ for food, housing, clothing, and medical expenses for her grandmother.

C. 42 U.S.C. 408(a)(4)
COU NT ______ [42 U .S.C. 408(a)(4)] Beginning in or around June 1995, and continuing without interruption until in or around July 2001, in Los Angeles County, within the Central District of California, defendant _____________, in a matter within the jurisdiction of the Social Security Administration, having knowledge of the occurrence of an event affectin g the continued right to Social Security Survivor's Insurance Benefits Payments of another individual in whose behalf defendant was receiving such paym ents, concealed and failed to disclose such event with the intent to fraud ulently secure payment when no payment was authorized. Specifically, defendant _____________ intentionally concealed and failed to disclose the death of his mother, ________, in ord er to continue to receive and spend S urvivor's Insurance Benefits payments made to his mother. By such action, defendant __________ stole approximately $____ ___ in Survivor's Insurance Benefits payments to which he knew that he was not entitled.

Count Two

Date 01/21/04

Document Statement for Determining Continuing Eligibility for T itle II Disability Paym ents

False Statement Responded "no" to question regarding whether he had worked under any other name or SSN since September 1998

D. 42 U.S.C. 408(a)(5)
COU NT ______ [42 U .S.C. 408(a)(5)] Beginning in or around May 1992, and continuing without interruption until in or around January 2000, in Santa Barbara County, within the Central District of California, defendant _____ ____, having made application to receive payment of Social Security child's insurance benefits payments for the use and benefit of another, and having received such paymen ts, knowingly and willfully converted such paym ents to a use other than for the use and benefit of such other person. Specifically, while acting as Representative Payee for her step son, _______,
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B. 42 U.S.C. 408(a)(3)
COU NT ________ [42 U .S.C. 408(a)(3)] On or about June 28, 2000, in Los Angeles County, within the Central District of California, defendant _____, in a matter within the jurisdiction of S SA , knowingly and willfully made materially false statements and represen tations in a R epresen tative Payee R eport (SSA F orm 623-OCR -SM ) used by SSA to
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defendant ___________ converted to her own use Social Security child's insurance benefits payments made to her on behalf of __________, and by such action obtained approximately $_________ in child's insu rance benefits payments to which she knew that she was not entitled.

8202-F6) to obtain Social Security benefits payments, knowing that said number had been obtained through his submission of an application to the Comm issioner of Social Security for a second Social Security Number, in which he had falsely denied that he had previously applied for and been granted another Social Security Num ber. 2. 42 U.S.C. 408(a)(7)(B) COU NT ______ [42 U .S.C. 408(a)(7)(B)] On or about M arch 14, 2000, in Los Angeles County, within the Central District of California, defendant _____ _____ _, for the purpose of obtaining something of value and for other purposes, and with the intent to deceive, falsely represented on an application for employment with __________ ___, that XXX -XX-XX XX was the Social Security Number assigned to him by the C ommissioner of Social Security, when in fact, as he well knew, such number was not the Social Security Number assigned to him by the Com missioner. 3. 42 U.S.C. 408(a)(7)(C) COU NT ______ [42 U .S.C. 408(a)(7)(C)] On or about M arch 13, 2001, in Los Angeles County, within the Central District of California, defendant _____ _____ _, knowingly possessed and intentionally used an altered, purchased, or counterfeited Social Security Number card, XXX -XX-XXXX, for the purpose of obtaining something of value and for other purposes. Specifically, defendant used a counterfeited Social Security card and Social Security Number XX X-XX -XXX X as proof of identification when completing an application and I-9 and W-4 forms to secure employment with ____ ___ _. VI.

E. 42 U.S.C. 408(a)(6)
COU NT ______ [42 U .S.C. 408(a)(6)] On or about August 4, 1999, in Los Angeles County, within the Central District of California, defendant _________, aka __________, for the purpose of obtaining a second identity, did knowingly, willfu lly, and with the intent to deceive the Commissioner of Social Security as to his true identity, furnish and cause to be furnished false information to the Commissioner of Social Security with respect to information required to establish and maintain records under the Social Security Act. Specifically, on a Form SS-5 (Application For Original Social Security Number Card), in response to the question "Has applicant or anyone acting on his/her behalf ever filed for or received a Social Security number card before?", defendant ________, posing as _____________, knowingly and with intent to deceive the Com missioner of Social Security as to defend ant's true identity, falsely answered "no."

F. 42 U.S.C. 408(a)(7)(A)-(C)
1. 42 U.S.C. 408(a)(7)(A) COU NT ______ [42 U .S.C. 408(a)(7)(A)] On or about ________ _, in Los Angeles County, within the Central District of California, defendant _________, aka ____________, in a matter within the jurisdiction of the Social Security Adm inistration, did willfully, knowingly, and with the intent to deceive and obtain a thing of value, use Social Security Number XXX -XX-XXXX, assigned to defendant by the Comm issioner of Social Security, having obtained that Social Security Account Number on the basis of false information furnished by defendant to the Comm issioner of Social Security. Specifically, defendant used Social Security Number XXX -XX-XXXX on a Statement for Determining Con tinuing Eligibility for SSI (SSA Form
14

Conclusion

The Social Security benefits programs are essential to the economic well-being of millions of Americans, and fraud is a serious problem within the Title II benefits programs. Millions of dollars are lost each year from fraud perpetrated against SSA by unscrupulous claimants and/or their representatives, and prosecution of Social Security fraud remains one of the most important priorities of the United States Attorneys' Offices, in cooperation with the Social Security
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Adm inistration Office of Counsel to the Inspector General. The opportunity for fraud is enhanced because SSA is an agency that has, historically, made extraordinary efforts to ensure accessibility to its benefits programs by qualified Am ericans. The Title II benefits programs can be properly characterized as serving as a lifeline to many needy Americans who otherwise would be unable to survive without the payments. Aggressive prosecution of Social Security fraud is essen tial to maintaining and preserving the integrity of the Social Security benefits programs, and to insuring that millions of Americans who rely on one or more of the SSA programs continue to have access to their lifelines.

ABOUT THE AUTHOR

John K. Webb is a Senior Attorney with the

Office of Chief Coun sel for the Inspector G eneral, Social Security Administration, and a Special Assistant United States Attorney with the United States Attorneys Office for the Central District of California, Los Angeles, where he serves as the Iden tity Theft Coordinator. He is responsible for prosecuting federal crimes involving identity fraud and abuse of Social Security programs, and has participated in the indictment and prosecution of individuals related to the terror attacks of 9/11, as well as the planning and implementation of Operation Tarmac/Operation Safe Harbor in Phoenix and Los Angeles. Mr. Webb has served as an instructor at the National Advocacy C enter and is a frequent lecturer on the topics of identity theft, Social Security number misuse, and Federal Benefits Fraud. Mr. Webb is a regular contributor to the United States Attorneys' Bulletin .a

Overview of the Felony Fraud Provisions of the Social Security Act

Jonathan Morse Program Specialist Office of Chief Counsel to the Inspector General Social Security Administration I. Introduction
Social Security fraud and identity theft involving Social Security cards and Social Security Num bers (SSNs) continue to be an increasing problem for investigators, prosecutors, and individual fraud victims. The Office of the Inspector G eneral of the Social Security Ad ministration (SSA/O IG) is charged with preventing fraud, waste, and abuse within the Social Security programs. Along with the Un ited States D epartment of Justice (Department)
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and the United States Attorneys' Offices (USAOs), the SSA/OIG utilizes the fraud provisions of the Social Security Act, Pub. L. No. 74-271 (1935), to punish and deter such crimes. The sheer enormity of the federal entitlement process makes Social Security benefits fraud difficult to detect and manage. In 2003 the Social Security Adm inistration (SSA ) distributed an estimated $494 billion in total benefits to recipients in the Old Age, Survivors, and Disability Insurance (OAS DI) and Disability Insurance (DI) programs. S OC . S EC . A DM IN ., T HE F ISCAL Y EAR 2005 B UDGET (Feb. 2004). Each month, SSA pays benefits to more than fifty-two million people. Id. Thus, while actual fraud totals are not precisely quantified, even a small percentage of fraudulent payments made in any of SSA's programs can reach staggering totals.

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SSN and Social Security card misuse is a growing threat to the public, particularly as the SSN em erges as the de facto national identifier. The Social Security Adm inistration issues approximately eighteen million new SSNs and cards each year. Id. SSN misuse is tied to many identity theft crimes, as criminals frequently use SSNs and Social Security cards to open credit card accounts and secure loans. In 2003 the SSA/OIG received 86,299 allegations of fraud concerning Social Security programs and SSN misuse. O FFICE OF THE INSPECTOR G EN ., S EMIANNUAL R EPORT TO C ONGRESS (Nov. 2003). Sections 208, 811, and 163 2 of the Social Security Act (the Act) provide penalties for fraud in Title II, Title VIII, and Title XVI cases, respectively. Section 208 is most often utilized for criminal prosecution of benefits and SSN fraud because this statute enumerates specific fraudulent acts. Sections 811 and 1632 are less detailed, providin g penalties for material false statements or representations in the application or receipt of benefits. As each of these statutes makes clear, Social Security fraud is a felony. Over the past twenty years, 208, 811, and 1632 of the Act have been am ended several times, most recently in 2004, to both broaden the range of proscribed cond uct and strengthen the penalty provisions. As criminals find new ways to com mit benefits fraud and identity theft, Congress continues to respond to the needs of law enforcement and the public by expanding these sections, especially 208. This article briefly describ es each statute and its legislative history, explains the Social Security Protection Act of 2004, H .R. 743, 108th C ong. (2004), and provides examples of how these statutes are ap plied in Social Security fraud cases.

statements of material fact formed the foundation for present-day section 208 pen alties. While 208 was included as part of the original Social Security Act of 1935 , the first substantive amendm ents came in 1958 as Congress added several provisions to broaden the scope of the statute. The 1958 am endments created penalties for false statements in cases where a person intentionally conceals or fails to disclose knowledge of an event affecting his or another individ ual's initial or continued right to payment. Pub. L. No. 85-840, 72 Stat. 1042 (1958). In addition, the 1958 amendment introduced a provision for instances where a person converts a payment that he or she receives for the use or ben efit of another. Id. As Congress identified new potential areas of fraud, these changes were the first to significantly expand the reach of 208. In 1972 Congress added misdemeanor fraud provisions to the Act in order to prevent individu als from obtaining Social Security benefits by using fraudulent SSN s. Social Security Amendments of 1972, Pub. L. No. 92-603, 86 Stat. 1363, 1364. This amendment prohibited the fraudulent use of an SSN to increase any benefit payment or to obtain any improper benefit under any federal benefits program . Id. However, this amendm ent proved insufficient to combat other forms of SSN misuse. In 19 76 Congress again expanded 208 to include a provision for those who misused SSNs "for any other purpose," no longer limiting the provision to receipt of unauthorized benefits. The 1976 report of the Senate Finance Committee justified the "for any other purpose" language, stating: While the Social Security Act currently provides criminal penalties for the wrongful use of a social security number for the purpose of obtaining or increasing certain benefit paymen ts, including social security benefits, there is no provision in the Code or in the Social Security Act relating to the use of a social security number for purposes unrelated to benefit payments. The committee believes that social security numbers should not be wron gfully used for any purpose. S. Rep. No. 94-938(I) (1976), reprinted in 1976 U.S.C .C.A .N. 3438, 3819. Thus, C ongress clearly intended to broaden the scope of the A ct to encompass a wider range of fraudulent acts.
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II. The legislative history of section 208

Section 208 of the Act, 42 U.S.C. 408, provides penalties for SSN misuse and fraudulent acts committed with the intent to receive an unauthorized paym ent. T he original statute enacted in 1935 sim ply provided, "Whoever in any ap plication for any payment under this title makes any false statement as to any material fact, knowing such statement to be false, shall be fined not more than $1,000 or imprisoned for not more than one year, or both." Pub. L. No. 74-271 (1935 ). This general prohibition against false

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Five years later, in 1981, Congress again amended 208. This amendment reclassified the offenses from misdemeanors to felonies and added the italicized language: "or for the purpose of obtaining anything of value from any person, or for any other purpose" to paragraph (7), discussing misuse of SSNs. The additional text broadens the range of acts covered under the statute and imposes stiffer penalties for violations. In 1984 Congress again stiffened 208 by adding penalties of up to $25,000 and imprisonment for up to five years for violations by representative payees or representative payee ap plicants. T his amendm ent also granted courts discretion to order partial or full restitution for representative payees convicted of willful misuse of funds. Pub. L. No. 98-460 (1984 ), available at http://policy.ssa.gov/ poms.nsf/lnx/0428080100.

concealm ent or failure to disclose events affectin g initial or con tinuing rights to paym ent; converting the benefits of one upon whose behalf an individual is receiving benefits; furnishing false information w ith the intent to deceive the Commissioner as to one's true identity; using an SSN obtained through false information to wrongfully obtain benefits; falsely representing an SSN as belonging to a person to whom it does not belong to obtain benefits wrongfully; altering or counterfeiting a Social Security card, or buying or selling a card so altered or counterfeited, or possessin g a Social Security card or counterfeit card with intent to sell or alter it; and disclosing, using, or compelling the disclosure of the SSN of any person in violation of federal law.

III. Section 208 today

In 2003 S SA made benefit payments to more than thirty-two million individuals under Title II of the Social Security Act. S OC . S EC . A DM IN ., T HE F ISCAL Y EAR 2005 B UDGET (Feb. 2004). Title II OA SD I benefit program s distrib ute benefits to retired workers and their dependents. The Disab ility Insurance B enefits Program (DIB), Retirem ent Insurance B enefits Program (RIB), Survivor's Insurance Benefits Program (SIB), and Representative P ayee Program (R ep Payee) are the most common program s und er this title. Section 208 sets out the felony fraud provisions for the OASDI program. Many instances of fraud involving Title II program s are the result of intentional false statements or representations of material facts to SSA on documents related to the application for, or periodic review of, benefit payments. Omissions may also constitute fraud under 208, such as when a beneficiary fails to report a new source of income, incarceration, or a new marriage. The enumerated acts constituting fraud under this section include: misrepresentations as to earnings and wages received and/or credited and the time period in which such earnings were paid; false statements or misrepresentations as to material facts in applications for benefits; false statements or misrepresentations of material facts used to determine rights to paym ent;

A violation of 208 can result in a fine of up to $250,000 and up to five years in prison.

IV. Sections 811 and 1632

Sections 811 and 1632 of the Act (42 U.S.C. 1011 and 42 U .S.C. 1383a, respectively) each contain the same provision for fraudulent acts pertaining to Social Security benefits. Both statutes provide that: (a) W hoever (1) know ingly and willfully makes or causes to be made an y false statement or representation of a material fact in any application for any benefit under this subchapter; (2) at any time knowingly and willfully makes or causes to be made an y false statement or representation of a material fact for use in determining rights to any such benefit; (3) having knowledge of the occurrence of any event affecting (A) his initial or continued right to any such benefit, or (B) the initial or continued right to any such benefit of any other individual in whose behalf he has applied for or is receiving such benefit, conceals or fails to disclose such event with an intent fraudulen tly to secure such benefit either in a greater amount or quantity than is due or when no such benefit is authorized ; or (4) having m ade application to
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receive any such benefit for the use and benefit of an other and having received it, knowingly and willfully converts the benefit or any part thereof to a use other than for the use and benefit of the other individual, shall be fined under Title 18, imprisoned not more than five years, or both. Criminal liability attaches under this provision when m aterial facts are withheld from the agency or where there is fraudulent intent to conceal events that would effect a benefit determination. A material fact has been interpreted as a fact that has the "propensity to influen ce agency action." United States v. Vaughn , 797 F.2d 1485, 1490 (9th Cir. 1986). In other words, a material fact is usually a fact that the Commissioner of Social Security may consider in determining entitlement to benefits.

fact that are made in connection with such applications or entitlement determinations. It also provides penalties for failure to disclose an event which affects entitlement or (in the case of representative payees) conversion of another's benefits to one's own use. In 1994 C ongress amended 1632 to reclassify violations of the statute as felonies and to include fines and terms of imprisonment of up to five years pursuant to Title 18. Until this year, the 1994 amendm ent was the only significant change in 1632 since 1972.

V. The 2004 amendments to sections 208, 811, and 1632

The Social Security Protection Act of 2004, H.R. 743 , 108th Cong. (2004), amended all three statutes to create felony fraud provisions in the Act. The fraud statutes, 208 of Title II (42 U.S.C. 408 (a)), 811 of Title VIII (42 U.S.C. 1011(a)), and 1632 of Title XVI (42 U.S.C. 1383a), were am ended to provide for mandatory restitution payments to the victims of fraud, defined as either an individual or the SSA. Previously, restitution w as not specifically required for a violation of the Act. The new provision enhances a judge's ability to compensate the Social Security programs or individ uals and to punish persons for violations including, but not limited to, im proper receipt of Social Security payments and misuse of SSN s. In February 2004 Congress passed the Social Security Protection Act, a far-reaching amendm ent to the Social Security Act that enhances protections for beneficiaries whose representative payees commit fraud, expands the civil monetary penalty program to encompass the withholding of material facts from SSA, strengthens penalties for the misleading use of Agency symbols or names, and authorizes judicial orders of restitution in cases of fraud. The fraud portion of the amendm ent, which modifies 208, 811, and 1632 of the Act, states that when a federal court sentences a defendant convicted under the Act, the court may order the defendant to make restitution to the victim of the fraud. Such restitution may be ordered in addition to, or in lieu of, any other penalty authorized by law. Moreover, if the court does not order restitution, the amendment requires the court to state why no restitution was ordered. Under this provision, a victim is defined as either an individual who suffers financial loss or
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A. Section 811
Title VIII established a benefits program for those World War II veterans who reside outside of the U nited States, and it pays retirem ent benefits to individuals who meet certain qualifications. Specifically, Title VIII applies to Filipino veterans who served under the Armed Forces of the United States between 1941 and 1946. 42 U.S.C. 1012. Because this statute specifies a target population, it will continue to have limited application as the number of veterans and their beneficiaries decreases. Section 811 provides penalties for those wh o com mit fraud in order to receive Title VIII benefits to which they are not entitled. Section 811's fraud provisions are sim ilar to those in 208 and 16 32, proscribing one from knowingly and willfully making a false statement or misrepresentation of a material fact in any application for benefits or in information used to determine any right to benefits, or concerning events which affect the initial or continuing right to benefits. In the past tw o years, the SSA /OIG has received only one allegation of fraud under 811 of the Act.

B. Section 1632
This statute pertains to applications for, and entitlement to, Supplemental Security Income (SSI) under Title XV I of the Social Security Act (42 U.S.C. 1383a). Section 1632 provides criminal penalties for false statements of material
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the SSA. Sp ecifically, the Commissioner of Social Security is the victim of the fraud where the defendant causes SSA to make a benefit payment that should not have been made, or where the defendant is serving as a representative payee for the person suffering the financial loss. In cases where restitution is ordered, funds paid to the SSA will be deposited in either the Federal Old-Age and Survivors Insurance T rust Fund (for Title II cases) or the Federal Disability Insurance Trust Fund (for Title XVI cases). This restitution provision brings the penalty statutes of the Act in line with other fraud statutes an d grants SSA more authority to recover lost funds in such cases.

multiple employers using a different name and SSN while receiving SSI benefits. An investigation by OIG Special Agents revealed that the individual was working under an alias and fictitious SSN from 1998 to 2003 in order to conceal incom e from S SA . See United States v. Do nna Chapm an (Shull) , No. 3:03-00233 (S.D. W. Va. 2004 ). As identity theft becomes more widespread, SSN misuse cases are also proliferating. In October 2002 an individual in Los Angeles was convicted un der 1632 (42 U.S.C. 1383a(a)(3)) for failing to report employment and a second SSN to S SA . The individual m isused the SS N of a private citizen to establish numerous credit and charge cards. During the execution of a search warrant, OIG Special Agents seized evidence of SSN misuse relating to other victims. The individual was sentenced to four months in prison and three years' probation, and was ordered to pay full restitution to SSA . See United States v. Margaret Jones, No. CR -02-0631-ER (C.D . Cal. 200 2). Cases such as these highligh t the way in which OIG Special Agents interact with USAOs to prosecute benefits fraud and identity theft cases. The OIG hopes to continue to foster relation ships and information sharin g with USA Os in order to aggressively pursue Social Security fraud and identity theft cases.

VI. Examples of cases prosecuted under sections 208, 811, and 1632
OIG Sp ecial Agents and United States Attorneys work together to prosecute many individuals each year for 208 and 1632 violations. In many cases, individuals are charged with multiple coun ts of frau d under multiple provisions of the Act. For example, in May 2003, the USA O in Philadelphia (E.D. PA.) prosecuted an individual who was receiving Title XVI Supplemental Security Income (SS I) benefits under her actual SSN, while working as a seasonal temporary worker for the Internal Revenue Service using a SSN that was issued to another individual born in 1987. The individual plead guilty to a three count criminal Information charging her with: Use of a False Social Security Number in violation of 42 U.S.C. 408(a)(7)(B); Fraud related to the Supplemental Security program in violation of 42 U.S.C. 1383a(a) (3)(A); and P ossession and U se of a False Identification Document in violation of 18 U.S.C. 1028 (a)(4). The individual was ordered to serve five years' probation and pay restitution to SS A in excess of $10,000. See Un ited States v. Arnetta Green-Jones , No. C R-02 -447 (E.D. Pa. 20 03). In Febru ary 2004 an individ ual plead guilty to Count Four of a four-count Indictment, which charged her with a violation of 1632 (42 U.S.C. 1383a(a)(2)) - providing a false statement to continu e Supplemental Security Incom e (SSI) disability benefits. The individual was sentenced in the Southern District of West Virginia to five years probation and ordered to pay $26,925 in restitution to SSA for providing a false statement on a form that determines a continuing right to benefits. The OIG received an allegation from a private citizen that the individual worked for
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VII. Further strengthening the penalties for fraud

Sections 208, 811, and 1632 cover a wide range of fraudulent acts relating to Social Security program s. However, as identity theft and benefits fraud increase, the statutes prohibiting such crimes also need to keep pace. As the SSN increasingly provides a gateway for criminals to fraudulently obtain other documents such as drivers' licenses, credit cards, or loans, the pressure on C ongress grows to find statutory solutions to deter and punish such crimes. In 2003 the SSA/OIG began working with the Department to introduce H.R. 2 971, 108th Cong. (2004) to further amend 208 of the Social Security A ct to enhance penalties when a fraudulent SSN is used to facilitate an act of terrorism, to facilitate drug trafficking, or in connection with a crime of violence. The legislative proposal is modeled after 18 U.S.C. 1028, which prohibits fraud and

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related activity with identification documents and information. Currently, 42 U .S.C. 1383a imposes a sentence of up to five years for a conviction under the title. H.R . 2971 prop oses a graduated penalty in which a second conviction under the statute would carry a sentence of up to ten years. The bill adds provisions for misuse of an SSN related to dom estic or international terrorism w hich would carry sen tence of up to tw enty-five years in prison, and proposes a penalty for fraudulent use of an SSN related to drug trafficking, which would carry a sentence of up to twenty years. Legislation such as H.R. 2971 is an example of how the OIG, D epartment, and other law enforcement agencies continue to work together to close loopholes and strengthen existing fraud laws.

ABOUT THE AUTHOR Jonathan M orse joined the Office of Chief Counsel to the Inspector General in the Fall of 2002. Since joining the OCC IG, he has worked on civil monetary penalty issues and legislative matters.a

Prosecuting Supplemental Security Income (SSI) Fraud: Punishing Abusers of the Nation's Federal Welfare Program
John K. Webb Special Assistant United States Attorney Central District of California I. Introduction
In 2003 the Social Security Administration (SSA) made m ore than $31.6 billion in benefits payments to more than 2.3 million beneficiaries of the Title XVI Supplemental Security Income (SSI) program. See S OC . S EC . A DMIN 2003 A NNUAL R EPORT OF THE SSI P ROGRAM , available at http://www.ssa.gov/OAC T/SSIR/SSI03/ssi TOC.html. SSI benefits payments are not the same as those paid from the Social S ecurity Title II programs, even though the SSI Program and the various Title II programs are administered collectively by SSA. The money for SS I benefits comes from general funds of the United States Treasury (Treasury), wh ile Social Security Title II
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benefits are paid from the contributions of workers, employers, and self-emp loyed people and are referred to as entitlement programs. However, a beneficiary under a Title II Social Security program may also be eligible to receive SSI under Title XVI as long as he meets the eligibility standards for disability, income, and resources. The S SI program is sometimes defined as a nationwide federal welfare program, administered by SSA and designed as a lifeline of last resort for the aged, blind, or disabled, whose income and resources are below specified levels. The program establishes that payment may be received as a right by those U.S. citizens or legally admitted aliens residing in this country, who qualify by meeting income an d resource criteria. No work credits are necessary to qu alify for SSI, and every SSI case is subject to review once a year to ensure that the recipients receiving checks are still

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eligible and are being paid the correct month ly amoun t.

II. Impact of fraud on the SSI program

Fraud is an inherent risk in SSA 's disability program s, and abuse in the SS I program is particularly prevalent. Some unscrupulous people view SSIs disability benefits as money waiting to be taken. A key risk factor in the SS I program is individu als who feign or exaggerate symptom s to become eligible for disability benefits and those who fail to report changes in resources or other circumstances that would make an SSI recipient ineligible to continue to receive S SI benefits payments. Eligibility for the SSI program is often complex and difficult to verify. SSI is awarded on the basis of financial need, as determined in relation to both income and resources (as those terms are defined for purposes of the Social Security Act (the Act)). Eligibility for SSI monthly cash benefits depends upon the severity of the applicant's condition, and the amount paid to each SSI recipient depends upon: (1) how much other income an individual receives; (2) the living arrangements of the individual; and (3) other circumstances that affect an individual's financial needs. SSA's ability to properly determine a recipient's continuing eligibility, and the correct monthly benefit due that recipient, is d irectly dependent upon SSA's on going access to accurate and current information regarding the recipient. To facilitate collection of information, SSA relies in large part on the honesty and good faith of the SSI recipient to provide accurate and timely information. Further, because an individu al's financial circumstances are prone to sudden change, SSA must frequently reassess a recip ien t's continuing eligibility for benefits. As a result, the SSI program tends to be difficult and labor intensive to adm inister and is often vulnerable to fraud and overpayments. Congress and SSA have collaborated to make fraud against the SSI program punishable as a felony, resulting in penalties of imprisonment up to five years and a fine of as much as $250,000. Most fraud involving the SSI program is the result of deliberate deception and arises when an applicant falsifies a document or record offered as proof of disability or continuing disability, or misrepresents material facts as to income or severity of disability on an initial application or report of continuing disability. SSI fraud can also
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be the result of omission when a beneficiary fails to report a change in circumstance, such as marriage, a new source of income, incarceration, removal from custodial care, or failure to report the death of a parent or spouse, while continuing to spend checks or direct deposits paid by SSA. The following violations are representative of violations that could result in criminal prosecution for SSI fraud: forging or falsifying SSI documents; conspiring to obtain or allow a false, fictitious, or fraudulent claim; making or causing to be made a false statement or representation of a material fact for use in determining rights to SS I benefits; making or causing to be made any false statement or representation of a material fact in any application for any payment or for a disability determination under the Social Security Act; concealing or failing to report any event affectin g the initial or continued right to payment received or to be received by a person, individually or on behalf of another; converting all or any part of a payment received on beh alf of a beneficiary to a use other than for the use and benefit of that beneficiary.

See 42 U .S.C. 1383 a(a)(1-4).

III. Legislative history and statutory authority

On O ctober 30, 1972, Congress enacted legislation under the Act authorizing creation of Title XVI (Supplemental Security Income for the Aged, Blind, and Disabled). See Pub. L. No. 9260 3, sec. 301. Title X VI sets forth the A ct's primary criminal provisions for prosecuting SSI fraud. See 42 U.S.C. 1383a(a)(1)-(4). The criminal penalties of Title XVI carefully spell out the Act's restraints on SSI fraud by specifying requ irements for disclosu re of specific events in the initial application process that identify facts that affect the applicant's right to payment of SSI benefits. Initially enacted as a misdemeanor statute (See Pub . L. No. 92-603, sec. 301), Congress amended Title XVI of the Act in 1994 to increase the penalty, m akin g SSI fraud a felony. See Independence and Program Improvements Act

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of 1994, Pub. L. No. 103-296, 206(c)(1), 108 Stat. 1464 (1994). The 1994 amend ments served to conform the specific crime of SSI fraud to the criminal sanctions already found in Title II (42 U.S.C . 408(a)(1)-(8)). T he statute is broadly written, and is paraphrased below:

A. Statutory authority: 42 U.S.C. 1383a(a)(1)-(4)

Section 1383a. Fraudulent acts; penalties; restitution (a) Whoever (1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit... (2) at any time knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining rights to any such benefit, (3) having knowledge of the occurrence of any event affecting (A) his initial or continued right to any such benefit, or (B) the initial or continued right to any such benefit of any other individual in whose behalf he has applied for or is receiving such benefit, conceals or fails to disclose such event with an intent fraudulently to secure such benefit either in a greater amount or quantity than is due or when no such benefit is authorized, or (4) having made application to receive any such benefit for the use and benefit of another and having received it, knowingly and willfully converts such benefit or any part thereof to a use other than for the use and benefit of such other person, shall be fined under Title 18, imprisoned not more than 5 years, or both. See 42 U .S.C. 1383a(a)(1)-(4).

a semblance of system integrity. Specifically, an SSI recipient m ust report: improvements in his medical condition; increase in work activity, including any increase in the amount of work; and amount of earnings. See 20 C.F.R. 404.1588; 416.988; 416.708(h). In addition, SSA maintains specific reporting requirem ents for SSI recipients that are related to the nondisability standards of SSI. These special reporting requirements relate to a recipient's financial circumstances and family composition, both of which can change significantly at a moment's notice, and will, upon change, affect the amount of SSI benefits paid to a recipient. While SSA does not require a recipient of SSI to report benefit cost-of-living adjustments, other important events must be revealed to SSA when they occur. These include any: change in the make-up of h ousehold; increase or decrease in income; increase or decrease in the income of an ineligible spouse living at home, a parent living at home if the recipient is a child, or an ineligible ch ild living at home. See 20 C.F.R. 416.708(a)-(c); receipt or disposition of resources by a recipient, his or her ineligible spouse, or the recipient's parent if the recipient is a child and the parent is living at home; eligibility of a recipient for benefits other than SSI; death of a recipient's eligible spouse, ineligible spouse living at home, or any other person living at home. See 20 C.F.R. 416.708(d), (e), (f)(1). In addition, an eligible spouse must report the death of anyone living in the household; an eligible child must report the death of a parent who was living at home; and, if a recipient has a representative payee, he or she must report the death of the payee. See 20 C.F.R. 416.708(f)(2)-(5); changes in marital status, including the marriage, divorce, or annulment of marriage of a paren t, if the recipient is a child. See 20 C.F.R. 416.708(g); adm ission to or discharge from a hospital, skilled nu rsing facility, intermediate care facility, or private institution. See 20 C.F.R. 416.708(k); and

B. Eligibility and continuing reporting requirements for SSI

Eligibility for Social Security benefits and the amoun t paid to eligible recipients can change with circumstances. Consequently, SSA has established specific criteria requiring S SI recipients to report changes in their circumstances. By doing so, SSA is able to increase its ability to m onitor eligibility of SSI recipients, which enables SSA to maintain
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termination of residency in the Un ited States, whether voluntary or by deportation, and any other departure from the United States for thirty or m ore consecutive days or for a full calendar month. See 20 C.F.R. 416.708(m)(n).

All SSI recipients, their eligible spouses and children, applicants awaiting a final determination of their claim, and representative payees, must make regular reports known as Continuing Disab ility Reviews. See 20 C .F.R. 416.704(a). SSA requires that an SSI recipient complete and submit a Continuing Disability Review within ten days after the end of the month in which an event affecting the eligibility of the recipient occurs. The Continuing Disability Review may be written, mailed, or delivered; or communicated by telephone or in person. See 20 C.F.R. 416.712; 416 .714(a).

penalty upon conviction for violation of the criminal provisions of the Title XVI of the Act may be a fine ($250,000), imprisonment (five years), or both. The following is an analysis of each section of the Title XVI felony fraud provisions, including elements and a short case study:

A. 42 U.S.C. 1383a(a)(1)
The elements required to prove a violation of 1383a(a)(1) are: defendant knowingly and willfully makes or causes to be made; any false statement or representation of a material fact; in any application for any benefit.

See 42 U .S.C. 1383a(a)(1). Criminal liability under 42 U.S.C. 1383a(a)(1) arises if an individual makes or causes to be made a false statement, or misrepresents a material fact, on any application for benefits. Exam ple 1. A defendant made false statements to the SSA in an application for payment of SSI benefits by stating that she had never before filed for benefits under any other name or Social Security Number (SSN) and had never used any SSN or name other than her own. In fact, the individ ual had created a false identity and used it to secure a second SSN, which she used to apply for SSI benefits. Example 2. An individual applied for SSI and stated on the initial application and subsequent Reports of Continuing Disability Review that he had no resources or assets that total more than $700, when in fact, the individual received a settlement on a personal injury suit that totaled $75,000 prior to filing his initial application for SSI. This constitutes fraud. In each example noted above, the individual can be charged with Social Security fraud under 42 U .S.C. 1383a(a)(1), as well as making false statements to a government agency under 18 U.S.C. 1001. Example 3. On his initial application for SSI benefits, the applicant falsely stated that he was disabled du e to a broken back, a bleeding ulcer, and hearing trouble, and that he had no income or resources. Based on his false application, SSA
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IV. Charging decisions and elements of the crime (42 U.S.C. 1383a(a)(1)-(4))
The purpose of the SSI criminal provisions (42 U.S.C. 1383a(a)(1-4)) is to maintain the integrity of the claims process and the SSI Program, as well as protecting SSI beneficiaries and the general public. In addition, among other things, the Federal Crim inal C ode generally prescribes fraud penalties as to acts involving false claims against the government and/or false or fraudulent statements made in matters before an agency. Th ese false and/or fraud ulent statements or actions can also be the result of omission, such as when a beneficiary or his representative payee fails to report a change in living conditions or circumstances. Because SSI is awarded solely on the basis of need and level of income, any adjustm ent in status of an SSI beneficiary as to marriage, a new source of income, incarceration, removal from custodial care, or the death of a parent or spouse, directly affects an individu al's eligibility to receive SSI. An individual receiving SSI, or any person receiving SSI payments on behalf of any SSI recipient (such as a representative payee) is required by SSA , as a condition of receiving SSI payments, to report any change in circumstances that would affect the recipient's eligibility to receive SSI. To combat fraud that is inherent in the SSI system, Congress increased the penalties for such fraud from misdemeanor to felony status in 1994 . See Pub. L. 103-296, 206(c)(1), 108 Stat. 1464 (1994). The

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determined that applicant was disabled and began making SSI payments. The applicant later filed a second application for SSI benefits in which he also made several false statements and om issions, including: He did not disclose that he had two other SSNs. He did not disclose that he was receiving unemployment compensation. He did not disclose that his wife was receiving unemployment compensation. He falsely stated that he had not received any income for a period of time prior to the application. He did not disclose material personal resources, includ ing a savings account. He did not disclose that he had received worker's compensation payments. He failed to reveal that he had purchased a grocery store, opened two bank accounts, and purchased five new automobiles.

Un ited States v. Rahim , No. 02-1405, 2002 WL 31898 228 (7th Cir. Dec. 27, 2002). Rahim pled guilty to one count of m ail fraud, was sentenced to twen ty-four m onth s imp risonment, and ord ered to pay $70,241.80 in restitution.

B. 42 U.S.C. 1383a(a)(2)
The elements required to prove a violation of 1383a(a)(2) are: defendant knowing and willfully makes or causes to be made; any false statement or representation of a material fact; for use in determining rights to any benefit.

See 42 U .S.C. 1383a(a)(2). Criminal liability under 42 U.S.C. 1383a(a)(2) arises if an individual makes or causes to be made a false statement, or misrepresents a material fact, used in determining entitlement to benefits. This usually occurs when an individual, while completing a Report of Continuing Disability Review or other SSA reporting document, makes any false statement that is material to a decision by SSA to continue to pay, or terminate, a claim for SSI benefits. For example, a false statement to SSA regarding marriage status, income, or cohabitation would be considered material to the decision-making process of SSA as to whether to continue to pay SSI benefits. The applicant unsuccessfully applied for SSI benefits in 1991, leaving blank the sections in the application asking for information about a spouse. In April 1993 the applicant successfully reapplied, this time noting that she was married to, but had for years been estranged from, her husband. The 1993 application informed applicant that she "must tell Social Security every time there is a change in her circumstances." The application listed the types of changes that must be reported by defendant, including changes in marital status (described as marriage, divorce, separation, or the resumption of cohabitation after a separation) and changes in "things of value that you own" for example, when "[y]ou buy or are given anything of value." In May 1993 the defendant and her husband bought a house, the defendant did not inform the SSA of either the marriage or the purchase of the house, and she continued to receive SSI payments.
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Shortly thereafter, the applicant completed a Statement for Determining Contin uing Eligibility for Supplem ental Security Income Paymen ts, in which he once again failed to reveal his use of other names and SSNs. He also did not disclose that he and his wife owned and operated a grocery store and that they were employed by, and earned money from, that grocery store. He also failed to disclose various assets, including bank accounts, life insurance policies, and automobiles. Based on the defendant's applications and his Statement for Determining Continuing Eligibility for Supplemental Security Income Payments, the applicant received SSI payments in the amount of $38,919, along with state benefits in the amount of $8,086. Additionally, because the applicant received federal SSI benefits, he was able to obtain Medicaid benefits in the amount of $23,235. As a result of this scheme, a federal grand jury returned a seven-count indictment against the applicant, alleging mail fraud (the defendant had received the SS I and Medicaid paym ents throu gh the United States mail), in violation of 18 U.S.C. 1342; making false statements in an initial application for SSI benefits, in violation of 42 U .S.C. 1383a(a)(1); and making false statements for use in determining the continuing right to SSI benefits, in violation of 42 U.S.C. 1383a(a)(2). See
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In the fall of 1996 SSA was notified of the defendant's m arriage and home ownership. In January 1997 the defendant went to an SSA office where she completed a Statement for Determining Continuing Eligibility for Supplemental Security Income Payments, in which sh e denied that there had been any change in her marital status and denied owning a home. Instead, she stated that she rented a home for $300 per month, and told SSA that she was still married to, but separated from, her husband. As a result of the scheme, a grand jury returned a five-count indictment against the defendant, including one count of making false statements for use in determining the continuing right to SSI benefits, in violation of 42 U.S.C. 1383a(a)(2), with all charges stemming from her repeated failures to inform the SSA of the fact that she had bought a house and was married to and living with her husband. See United States v. Gardner, No. 03-4018, 2003 WL 21940628 (4th Cir. Au g. 14 , 2003). She was convicted on all counts. A claimant for, or recipient of, SSI benefits may be held criminally liable for knowingly and willfully taking material actions intended to fraudulently secure benefits to which he is not entitled. See POMS SI 04070.020 ; available at http://policy.ssa.gov/poms.nsf/lnx/050407002 0!op endocument.

Criminal liability under 42 U.S.C. 1383a(a)(3) arises if an individu al knowingly conceals a fact to secure a benefit to which he is not entitled. For example, a defendant, when completing questions about his work activities, falsely stated on an SSA form that he had not worked for four years and was disabled and unable to perform work. In truth, defendant was working at the time he completed the S SA form and had been employed full time for several years as a computer worker by the Internal Revenue Service. See United States v. Allen, No. CR 03190 -ABC (C .D. C al. Jan. 21, 2003). An "intent to defraud" is an intentional deception or misrepresentation which the individual knows to be false or which he does not believe to be true, but makes knowing that the deception could result in some unauthorized benefit to himself or some other person. See PO MS, supra , at GN 0410 5.005(B)(4). A person has "fraudulent intent" if he knows that he is legally obligated to disclose certain information and that, by withhold ing that information, h e will receive greater paymen ts than he is entitled to receive. The SSA may establish fraudulent intent if the claimant's behavior is so devious and uncharacteristic of an innocent person that a jury could infer that he must have known he was doing wrong. See United States v. Phillips, 600 F.2d 535 (5th C ir. 1979). A defendant filed for and received Social Security disability benefits over a seven-year period. Unbeknownst to the government, the defendant obtained the benefits through false statements on her applications that she did not have any independent sources of income. To the contrary, she earned a living during the period in question by babysitting children who lived in her neighborhood. She also worked as a substitute teacher and, along with her husband, received proceeds from rental property. The defendant also failed to disclose that she co-owned several bank accounts. After a brief investigation, SSA discovered that the defendant had made numerous misrepresentations in her applications and terminated her disability benefits in July 1997. The defendant was convicted on five counts of theft of governm ent property (Social Security disability benefits), in violation of 18 U.S.C. 641; five counts of concealing and failing to disclose information, in violation of 42 U.S.C. 1383a(a)(3); and two counts of making a false statement to obtain Social Security disability

C. 42 U.S.C. 1383a(a)(3)
The elements required to prove a violation of 1383a(a)(3) are: the defendant received Social Security benefits on his own or on behalf of another person; the defendant had knowledge of an event affecting his or the other person's initial or continued right to Social Security benefits payments; the defendant knowingly concealed or failed to disclose this event to the Social Security Administration; and the defendant concealed or failed to disclose this event to the Social Security Ad ministration with the intent to fraud ulently secure payment of Social Security Income benefits in an amount greater than was due the other person or when no payment to the other person was authorized.

See 42 U .S.C. 1383a(a)(3).

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benefits, in violation of 42 U .S.C. 1383a(a)(2). She was sentenced to a twenty-one month term of imprisonment and ordered to m ake restitution. See United States v. Khatami, 280 F.3d 907 (9th C ir. 2001); see also United States v. Jackman , No. 9640069-01, 1996 WL 772607 (D. Kan. Dec. 30, 199 6).

it on May 1, 1995. Defendant was indicted for failing to disclose an event affecting her right to SSI (42 U.S .C. 1383a(a)(4)) and embezzlement. See United States v. Martinez, No. 02-41461, 200 3 W L 22002 566 (5th C ir. Aug. 21, 2003).

V. Sample indictments
The following are samples of indictments of SSI fraud using the Title XVI felony fraud provision s.

D. 42 U.S.C. 1383a(a)(4)
The elements required to prove a violation of 1383a(a)(4) are: defendant knowingly and willfully converts; a benefit, or any part of a benefit; received on for the use and benefit of another; to a use other than for the benefit of the other person.

A. 42 U.S.C. 1383a(a)(1)
COU NT ______ [42 U .S.C. 1383a(a)(1)] On or about September 4, 1999, in Los Angeles County, within the Central District of California, defendant ______ knowingly and willfully made a false statement and representation of material fact for use by the Social Security Administration in determining rights to Social Security Supplemental Security Income Benefits payments. Specifically, when completing an initial Application For Supplemental Security Income, defendant ________ falsely stated that he was not working and had not w orked since January 1990. In truth and in fact, as defendant well knew, he was working as a ___________, wh ere he had been employed since 1988.

See 42 U .S.C. 1383a(a)(4). Criminal liability under 42 U.S.C. 1383a(a)(4) arises if an individu al knowingly and willfully converts to an unauthorized use a benefit that h e has accepted as payee on another's behalf. For example, a criminal violation occurs if a defend ant applies (a formal application to become Representative Payee is required by SSA) to become the Representative Payee for the use and benefit of an other (spouse, parent, grandparent, child, friend), and, having received payment(s) of a benefit from SSA on behalf of another, knowingly and willfully converts the payment(s) to his own use, rather than for the use and benefit of the intended beneficiary. A common violation occurs when a Representative Payee intentionally conceals the death of another in order to continue to receive and spend the benefits payments made by SSA to the Representative Payee. In 1989, 1990, and April 1992 the defendant applied to SSA for SSI benefits. On each occasion, her application was rejected because her husband's income was too high. The defendant again applied in July 1992 (prior to that application, an Adm inistrative Law Judge had determined she was disabled). That application was again denied due to the defendant's husband 's income. On or about April 1995, when defendant filed a fifth SSI application, she stated to the SSA that her husband had moved ou t of their house on Ap ril 1, 1995. She stated that her husband would continue to pay bills, but the resulting loss of income qualified her for SSI. She began to receive
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B. 42 U.S.C. 1383a(a)(2)
COU NT ______ [42 U .S.C. 1383a(a)(2)] On or about January 16, 2004, in Los Angeles County, within the Central District of California, defendant, _________, knowingly and willfully made a false statement and representation of material fact for use by the Social Security Ad ministration in determining rights to Supplemental Security Income payments. Specifically, on a Report of Contin uing Eligibility Interview (SSA Form 454-BK) dated January 16, 2004, defendant _________ answ ered "no" to question #11, which asked: "since you became disabled, have you done work?" In truth and in fact, as defendant _________ well knew, at the time he completed the SSA Form he was working
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full-time as a repair technician while using his son's social security number (XXX -XX -XX XX ).

C. 42 U.S.C. 1383a(a)(3)
COU NT ______ [42 U .S.C. 1383a(a)(3)] On or about January 6, 1999, in Los Angeles County, within the Central District of California, defendant ______, aka ______, in a m atter within the jurisdiction of the Social Security Administration, having knowledge of the occurrence of an event affecting his initial or continued right to payment of Title XVI Supplemental Security Income benefits, concealed and failed to disclose such event with the intent fraudulently to secure payment in an amount greater than was due him, or when no payment was authorized. Specifically, on a Statement for Determining Continuing Eligibility for Supplemental Security Income (SSA Form 8202F6) defendant ____ __ concealed from the Social Security Administration that he was employed and receiving T itle II Social Security D isability Income Benefits paym ents under a second identity and Social Security Num ber in order to deceive the Social Security Administration into making benefit payments when he was otherwise ineligible to receive such payments.

continue to receive and spend Supplemental Security Income Benefits paymen ts paid to ________ by the Social Security Administration. By such action, defendant _______ stole approximately $______in Supplemental Security Income Benefits payments to which she knew that she was not entitled.

VI. Conclusion
The Supplemental Security Income program can be properly characterized as a lifeline to many needy Americans, who would otherwise be unable to survive without the payments. Access to SSI must be protected. Millions of dollars are lost each year from fraud perpetrated against SSI by unscrupulous claimants and/or their representatives, and prosecution of SSI fraud remains one of the most important priorities of the United States Attorneys' offices in cooperation with the Social Security Adm inistration Office of Counsel to the Inspector G eneral. The opportunity for fraud is enhanced because SSA is an agency that has, historically, mad e extraordinary efforts to ensure accessibility to its benefits programs by qualified Am ericans. Aggressive prosecution of Social Security fraud is essential to maintaining and preserving the integrity of the Social Security benefits programs, and to insure that millions of Americans who rely on one or more of the SSA programs continue to receive their lifeline. ABOUT THE AUTHOR

D. 42 U.S.C. 1383a(a)(4)
COU NT ______ [42 U .S.C. 1383a(a)(4)] Beginning in or around April 1999, and continuing without interruption until in or around Sep tember 1999, in Los An geles County, within the C entral District of California, defend ant, _____ ___, in a matter within the jurisdiction of the Social Security Administration, having made application to receive Supplem ental Security Income Benefits payments as Representative Payee for the use and benefit of her son,______ _____ , and having received such benefits payments, know ingly and willfully converted the benefits payments for her own use rather than for the use and benefit of her son. Specifically, defendant _______, while acting as Representative Payee for her son, __________, failed to disclose _________'s death in order to
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John K. Webb is a Senior Attorney with the

Office of Chief Coun sel for the Inspector G eneral, Social Security Administration, and a Special Assistant United States Attorney with the United States Attorneys Office for the Central District of California, Los Angeles, where he serves as the Iden tity Theft Coordinator. He is responsible for prosecuting federal crimes involving identity fraud and abuse of Social Security programs, and has participated in the indictment and prosecution of individuals related to the terror attacks of 9/11, as well as the planning and implementation of Operation Tarmac/Operation Safe Harbor in Phoenix and Los Angeles. Mr. Webb has served as an instructor at the National Advocacy C enter and is a frequent lecturer on the topics of identity theft, Social Security number misuse, and Federal

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Benefits Fraud. Mr. Webb is a regular contributor to the United States Attorneys' Bulletin .a

Prosecuting Social Security Recipients for False Endorsement of Treasury Checks

Judith Ringle Attorney Office of Chief Counsel to the Inspector General Social Security Administration I. Introduction
A rarely used theory of liability may enhance prosecutions under certain statutes criminalizing false statements made to the federal governm ent. The theory is simp lethe endorsem ent of a United States Departm ent of Treasury (Treasury) check, when the signer knows he or she is not eligible or entitled to receive the funds, constitutes an actionable false statement that the individu al is entitled or eligible to receive the funds. T his theory has been endorsed in reported opinions under 18 U.S.C. 1001, and under 42 U.S.C. 408(a)(3), an antifraud provision of the Social Security Act (the A ct). members of a deceased worker who paid Social Security taxes. Id . Disability benefits are paid to insured individuals who meet the statutory definition of disability, i.e., an inability to engage in any substantial gainful activity. Id. at 402, 423 . 42 U.S.C. 408(a)(3) makes it a felony to "at any time make[] or cause[] to be made any false statement or representation of a material fact for use in determining rights to paymen t under" Title II of the Social Security Act. In contrast to the antifraud provision of 408(a)(3), 18 U.S.C. 1001 makes it a felony to: (1) falsif[y], conceal[ ], or cover[ ] up by any trick, schem e, or device a material fact; (2) make[ ] any materially false, fictitious, or fraudulent statement or representation; or (3) make[ ] or use[ ] any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry;

II. Background: Social Security Programs and the false statement provisions42 U.S.C. 408 and 18 U.S.C. 1001
Title II of the Act sets out the Old Age Disability and Security Incom e program. It provides for old -age, su rvivor, and disab ility benefits for insured individuals irrespective of financial need. See 42 U.S.C. 402, 423. Insured status is acquired by earning "quarters of coverage" through covered employment. Id. at 413, 414. Old-age benefits are the well-known Social Security retirement benefits. Id. at 402. Survivor's benefits are paid to certain fam ily
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in any matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States. Violations of 42 U.S.C. 408(a)(3) and 18 U.S.C. 1001 are punishable by a fine under Title 18 or imprisonment for not more than five years, or both. Materiality is an essential element of each offense and, under both statu tes, courts generally apply identical standards for determining materiality. A material fact is one that has a natural tendency to influence, or is capable of influencing, the Social Security Administration

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(SSA) or the governm ent agency or department in question. United States v. Price , No. 00-10151, 2001 WL 488896 (9th Cir. May 8, 2001) (materiality under 42 U.S.C. 408(a)(3)); United States v. Valdez, 594 F.2d 725, 728 (9th Cir. 19 79) (m ateriality under 18 U .S.C. 1001). Reported opinions interpreting the essential elements of an offense under 18 U.S.C. 1001 and 42 U.S.C. 408(a)(3) reveal the extent to which the tw o provisions contrast. Proof of five elements is essential to sustain a conviction under 18 U.S.C. 1001: "a statement, falsity, materiality, specific intent, and agency jurisdiction." United States v. Boone , 951 F.2d 1526, 1544 (9th Cir. 1991) (citing United States v. Lange, 528 F.2d 1280, 1287 (5th Cir. 1976)). In contrast, by its terms, 42 U.S.C. 408(a)(3) requires only proof that the defendant made a false statement or representation of a material fact for use in determining rights to paym ent under Title II of the Act. Wh ile specific intent is a crucial element of an offense under 18 U.S.C. 1001, Boone , 951 F.2d at 1545, courts appear to have split on whether 42 U.S.C. 40 8(a)(3) is a specific intent crime. Citing the omission of any statutory language regarding intent, as compared to other subsections under 42 U .S.C. 408, the Sixth Circuit held that 408(a)(3) does not include the element of specific intent to make a false representation. Un ited States v. Adair , No. 88-1264, 1988 WL 114791 (6th Cir. Oct. 31, 1988) (citing United States v. Morrison , 43 F.R.D. 516, 518 (N.D. Ill. 1967)). Indeed, in contrast to 42 U.S.C. 408(a)(3), 408(a)(4) makes it a felony to: hav[e] knowledge of the occurrence of any event affecting (1) his initial or continued right to any payment under this title [42 U.S.C. 408], or (2) the initial or continued right to any payment of any other individual in whose behalf he has applied for or is receiving such payment, conceal[], or fail[] to disclose such event with an intent fraudulen tly to secure payment either in a greater amount than is due or when no payment is authorized.... However, in contrast to the Sixth Circuit in Adair , the Eighth Circuit has stated (without significant discussion) that specific intent is an essential element of a violation under 42 U.S.C. 408(a)(3). United States v. Cacioppo , 517 F.2d 22, 23 (8th Cir. 1975). Given the text of 42 U.S.C. 408(a)(3), especially as it compares to other subsections under 408, it would appear that the
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Sixth Circuit approach is better supported by the wording of the statute. Consequently, the immediate advantage to charging a 42 U.S.C. 408(a)(3) violation is that proof of know ledge that the false statement will effect initial or continued rights to payment under Title II may not be required.

III. Treasury check endorsements, made with knowledge that the endorser is not entitled to or eligible for the funds, constitute false statements A. Check endorsements as false statements in criminal prosecutions
In Morrison , 43 F.R.D . at 517, one count of a ten coun t information charged the defend ant w ith willfully and knowingly concealing and failing to disclose the death of her m other to the SSA, with inten t to fraud ulently secure paym ent of widow's benefits when no such payments were authorized, in violation of 42 U.S.C. 408(a)(4). The remaining nine counts ch arged the defendant with making and causing to be made false statements and representations of a material fact by endorsing Title II benefit checks, thereby falsely representing the rights of her deceased mother to receive the payments, in violation of 42 U.S.C. 408(a)(3). Id . The defendant, among other things, challenged the legal sufficiency of the nine counts pertaining to the check endorsem ents. However, the defendant did not argue that a Treasury check endorsement could not equate to a false statement made for use in determining rights to payment under Title 42, as prohibited under 42 U.S.C. 408(a)(3). Instead, the defendant argued that the counts were duplicitous, a defense easily dismissed by the court, which observed that "[c]ounts two through ten are not duplicitous since each alleges a separate offense." Id . at 518. Con sequently, the District Court for the Northern District of Illinois held that the prosecutor's allegation that the defendant m ade and caused to be made false statem ents and representations of a material fact by endorsing several checks, thereby falsely representing the rights of her deceased mother to receive Title II benefits, stated a cause of action under 42 U .S.C. 408(a)(3). Check endorsements have also been treated as false statements in at least one reported case under
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18 U.S.C. 1001. In Gilbert v. United States, 359 F.2d 285 (9th Cir. 1966), the defendant, an accountant filing tax returns on behalf of others, was charged with violating 18 U.S.C. 1001 because he endorsed tax refund checks, a matter within the jurisdiction of a governm ent agency, with the client's name "R. Milo Gilbert, Trustee," when, in fact, he had not informed the clients that they qualified for a refund and did not remit the refund to the clients. The defendant asserted that no falsity was involved with the Treasury check endorsements because the endorsements were precisely wh at they purported to be he w as, in fact, the authorized tax preparer when he endorsed the checks. Id . at 286. Rejecting the defendant's contention and upholding his conviction, the Ninth Circuit stated that the check endorsements constituted false statements because the defendant's "endorsem ents themselves constituted representations that he was duly authorized to make them." Id . Moreover, the Ninth Circuit also dismissed the defendant's argum ent that the false representations, if any, were made to a bank, and not to the government directly, as required under 18 U.S.C. 1001. The court stated that 18 U.S.C. 1001 contains no language requiring the false statement be made directly to the federal governm ent. T he N inth Circuit noted that "[the defendant] certainly was aware that the endorsement of the checks was the first crucial step in their journey to the T reasury Departm ent w here they would be ultimately presented for payment." Id . at 287. Gilbert and Morrison have both been cited with ap proval. See Un ited States v. Adair , No. 881264, 1988 WL 114791 (6th Cir. Oct. 31, 1988) (citing Morrison ); United States v. Yermian , 708 F.2d 365 (9th Cir. 1983) (citing Gilbert ). Nevertheless, it appears that Gilbert and Morrison may represent the sole published authority specifically supporting the theory that a Treasury check endorsement made with knowledge that the signer is not entitled to or eligible for the funds, constitutes an actionable false statement under the criminal false statement provisions of the U.S. Cod e.

of Treasury checks are more often prosecuted under 18 U .S.C . 641, which "deals generally with conversion of govern ment property." Un ited States v. Irvin , 67 F.3d 670 (8th Cir. 1995). Section 641 makes it a crime to Em bezzle[ ], steal[ ], pu rloin[ ], or knowingly convert[ ] to his use or the use of another, or without authority, [to] sell[ ], convey[ ] or dispose[ ] of any record, voucher, money, or thing of value of the United States or of any department or agen cy thereof, or any property made or being made under contract for the United States or any department or agency thereof; or...[to] receive[ ], conceal[ ], or retain[ ] the same with intent to convert it to his use or gain, knowing it to have been embezzled, stolen, purloined or converted. 18 U.S.C. 641. A 641 violation is a felony only if the value of the property converted exceeds $1,000; otherwise it is charged and pun ished as a misdemeanor. In Irvin , the defendant received a Treasury check in the amount of $836,939.19. He knew that this ch eck w as not correct and that, upon his discharge from the United States Army, the government actually owed him only $183.69. Id. at 671. Irvin deposited the check in his personal savings account and used the proceeds to pay off his father's mortgage, purchase two vehicles, and for other transactions. Id . Irvin claimed that he believed that the Treasury check was a "miraculous answer to his prayers" rather than a government mistake. Id. Stating that 641 could apply even when the perpetrator does not obtain the funds through fraud , the E ighth Circuit held that the defend ant violated 641 for knowingly converting federal funds. Id. at 672. Under the theories espoused in Gilbert and Morrison , it appears that the government might also have proceeded under 18 U.S.C. 1001. Likewise, in United States v. McRee , 7 F.3d 976 (11th Cir. 1993), the defendant received and deposited a Treasury check she knew had been issued in error by the Internal Revenue Service, in the amount of $359,380 .25. The defendant then engaged in a series of transactions designed to transform the money into "spendable cash," engaging in over thirty checking transactions involving amounts less than $10,000.00, in order to avoid applicable bank reporting requirements for transactions involving more than $10,000.00.

B. Comparison of other criminal prosecutions involving wrongful endorsement of Treasury checks

Cases involving the wrongful and knowing receipt of federal funds through the endorsement
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In connection with this scheme, the defendant was charged with violating 18 U.S.C. 641, among other statutes. She argued that she could not be convicted under 641 because she did not obtain the Treasury check through fraud and that the funds ceased to constitute federal funds upon issuance of the Treasury check. The E leventh Circuit held that the Treasury check represented federal funds, and the government, at all times, retained a property interest in the m oney. Id . at 981. The Eleventh Circuit further held that conversion in violation of 641 may occur even where the initial possession of the funds is entirely lawful. Id . Again, under the theories espoused in Gilb ert and Morrison , it appears the government could also have proceeded under 18 U.S.C. 1001. The benefit of proceeding under 18 U.S.C. 1001 is the absence of a monetary requirement. The Ninth Circuit has stated: The offense of making a false statement does not include monetary value as an element. Compare 18 U.S.C. 1001 with 18 U.S.C. 641 (setting $1,000 cut-off for felonies). It is therefore immaterial whether the false statement involved more or less than $1,000. Cf. United States v. Medina de Perez , 799 F.2d 540, 542 (stating that pecuniary loss is not an elemen t of 1001). United States v. Headdress , No. 00-30303, 2001 WL 10060 97 (9th Cir. Aug. 13, 2001). Consequently, a misdemeanor offense under 641, if it involves a false statement, may be charged as a felony under 18 U.S.C. 1001. It is clear, of course, that even when a criminal provision of the U.S. Code provides for a misdemeanor and is more closely related to the facts of a criminal act, the prosecutor is free to proceed under an available felony provision of Title 18, if the prosecutor so chooses. It is well settled that "when an act violates more than one criminal statute, the government may prosecute under either so long as it does not discriminate against any class of defendants." United States v. Batchelder, 442 U.S. 114, 123-24 (197 9). See also Garrett v. United States, 471 U.S. 773, 778 (1985); United States v. Cavada, 821 F.2d 1046, 1048 (5th Cir. 1987). The only exception arises where Congress clearly intended that one statute supplant another. The fact that one statute is more specific than the other is not sufficient. See United States v. Zabel, 702 F.2d
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704, 707-08 (8th Cir. 1983). Nor does the fact that one statute prescribes a felony and the other prescribes a misdemeanor affect the prosecutor's authority to choose am ong statutes. See Cavada, 821 F.2d at 1048-49; United States v. Hopkins , 916 F.2d 207, 212 (9th Cir. 1990); United States v. Barrett, 837 F.2d 933 (10th Cir. 1988); United States v. Edmonson , 792 F.2d 1492 (9th Cir. 1986). This conclusion has also been reached in prosecution s under the Social Security Act. Un ited States v. Sm ith , 523 F.2d 771, 780 (5th Cir. 19 75). Note. On July 15, 20 04, President Bush signed into law H .R. 1731 , the Identity Theft Penalty Enhancement Act, Pub. L. No. 108275. Section 4 of this new law amends 18 U.S.C. 64 1 to permit the aggregation of amounts, from all counts for which a defendant is convicted in a single case, for purposes of calculating the value of stolen property.

C. Check endorsements constitute false statements in a civil prosecution under the Social Security Act
In a recent administrative matter, In re Clara Sloan, CR No. 1081, 2003 HHSD AB LEX IS 116 (Sept. 10, 2003), an Adm inistrative Law Judge (ALJ) of the Health and Hum an Services Departmental Appeals Board (DAB) endorsed the theory that a signature on a Treasury check constitutes a false statement to the SSA under 42 USC 1320a-8, the civil false statement provision under the Act, if the endorser knew or should have known that he was not eligible to receive the fund s. 42 U.S .C. 1320a-8 prohibits individ uals from mak[ing], or caus[ing] to be made, a statement or representation of a material fact for use in determining any initial or continuing right to or the amount [of Title II benefits] that the person knows or should know is false or misleading or knows or should know omits a material fact or makes such a statem ent w ith knowing disregard for the truth. A material fact is one that the Commissioner of Social Security may consider in evaluating whether an applicant is entitled to benefits under Title II. 42 U.S.C. 1320 a-8(a)(2). A penalty of up to $5,000 m ay be imposed for each false
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statement. In addition, an assessment may be imposed in an amount up to twice the amount of benefits received as a result of the false statement or representation. Sloan received Title II survivor's benefits as representative payee for her disabled son and also received mother's benefits for herself based on her role as caretaker of her son. 20 C.F.R. 404.339, 404.350, and 404.2010. U nder Title II of the Act, no benefits may be paid to a beneficiary during any month the beneficiary is incarcerated. 20 C.F.R. 404.468. Because Sloan's benefits were derived solely from her role as caretaker for her son, any incarceration of her son would extinguish her eligibility for mother's benefits as well. Id . Sloan's son was incarcerated on two separate occasions during the 1980's and 1990's, and because she failed to notify the SSA of the incarceration, Sloan received over $45,000.00 in Title II benefits for which she and her son were not eligible. The SS A O ffice of the Inspector General (OIG) received an allegation regarding Sloan, and eventually charged Sloan with fourteen violations of 42 U.S .C. 1320a-8, based on fourteen benefit checks signed by Sloan. (The failure to notify SSA constituted a felony under 42 U.S.C. 408(a)(4), but did not constitute a violation of 42 U.S.C. 1320a-8.). Sloan requested a hearing and admitted she signed the checks. She claimed she did not realize that the son's incarceration extinguished eligibility under the Title II benefits program. A Social Security employee testified that Sloan received yearly notification of the requirement to report any incarceration of the beneficiary and further testified that SSA considered each check endorsement as a statement that the beneficiary (or representative payee) contin ued to be eligible to receive the funds. SSA/OIG argued that whether checks continue to be endorsed is certainly a fact that the Comm issioner may consider in making a continuing eligibility determination, because each signature represents the beneficiary's assertion that eligibility continues. SSA/OIG further argued that the yearly notification received by Sloan showed that Sloan knew, or should have known, her duty to report the incarceration and return any benefits received. T he A LJ agreed and imposed a civil monetary penalty in the amount of $35,000, as requested by the SSA/OIG. Ms. Sloan appealed,
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and the DAB declined to disturb the A LJ's order, as did the Comm issioner of Social Security. Ms. Sloan is pursuing an appeal to the Court of Appeals for the Ninth Circuit.

IV. Future considerations

Of course, as electron ic bankin g con tinues to become more prevalent, the instances of issued and endorsed physical Treasury checks may decline. On April 26, 1996 President Clinton signed into law the Debt Collection Improvement Act of 1996, Pub. L. No. 104-134, 110 Stat. 1321, 1358 (codified at 31 U.S.C. 3332). This law requires all federal payments to be issued electronically by January 2, 1999, with exceptions to be determined by Treasury in cases of hardship and other circumstances. 31 U.S.C. 3332(f). Treasury's use of direct deposit into bank accounts has increased as a portion of all federal benefit paym ents from fifty-eight percent in 1996 to seventy-seven percent in 2002 . Michael S. Barr, Banking the Poor, 21 Y ALE J. ON R EG . 121, 185 (2004). The 1996 W elfare Reform law mandated that states convert from paying fed eral welfare benefits in the Temporary Assistance for Needy Families program by check to making such payments electronically. The Personal Responsibility & W ork O pportunity Reconciliation Act of 1996 (Welfare Reform Law), Pub. L. No. 104-193, 110 Stat. 2105, 2324 (199 6). Unfortunately, the knowing receipt of federal benefits by electronic funds transfer or direct deposit does not appear, under any theory, to amount to an actionable false statement. In United States v. Spear, 734 F.2d 1 (8th Cir. 1984), the defendants appealed their convictions for conversion of Social Security benefits under 18 U.S.C. 641, and other crimes. Regarding the 641 charge, the defendants continued to receive a deceased relative's Social Security benefits by direct deposit into an account held jointly with the beneficiary. In dicta, the E ighth Circuit strongly suggested an action under 42 U.S.C. 408 of the Act would not lie for the wrongful receipt of benefits by direct deposit. "[T]he conduct for which the [defend ants] were prosecuted plainly does not fit within any of the provisions of section [42 U.S.C. 408]." Id. at 2.

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V. Conclusion
Charging a Treasury check endorsement as an actionable false statement a false statement that the signer is entitled to or eligible to receive the funds can provide an alternative means of prosecution under 18 U.S.C. 1001 and 42 U.S.C. 408 in circumstances that are otherwise problem atic. In conn ection with the A ct, proceeding under the signed check theory can avoid problems of proof that may arise in other contexts, especially if the defendant's false statements to SS A are arguably ambiguous, or if the beneficiary made no statements to the SSA during the period of improper receipt of benefits. Moreover, m any times a beneficiary will claim that SSA was fully informed of facts that would alter or terminate eligibility, but continued to send the benefit checks, wh ich the beneficiary continu ed to receive, endorse, and negotiate. In such instances, the check endorsement may constitute a later false statement of continuing eligibility to SSA . Under Title 18 of the U.S. Code, charging violations of 1001 rather than 641, focusing on the Treasury check endorsements instead of the possible charge of conversion, can permit the illegal receipt of federal funds to be charged as a felony rather than a misdemeanor in circumstances where the check amount does not meet the felony threshold under 641.

Legislation adopted in the past decade has required the federal government to increase use of electronic funds transfers in place of Treasury checks. A s ban king practices advance, it is likely that the use of electronic funds transfers will increase, replacing Treasury checks to a great extent. In order to prosecute the illegal receipt of federal fun ds effectively, it may be advisable to formulate new legislation to sp ecifically criminalize the knowing receipt of federal funds improperly obtained through electronic funds transfers. In the meantime, strengthening 18 U.S.C . 641 to permit the aggregation of all converted amoun ts for which a defend ant is convicted, for purposes of calculating the value of stolen property, will allow a continuing pattern of conversion of small amounts to be charged as a felony. ABOUT THE AUTHOR

Judith Rin gle is a general attorney for the Social Security Administration Office of the Inspector General, where she has been employed for the past eight years. Prior to her tenure as a general attorney, she served as A ttorney-Advisor, Trial Attorney, and Counsel to the Inspector General for the Commodity Futures Trading Comm ission a

Prosecuting Representative Payee Fraud: Protecting the Needy from Predators

John K. Webb Special Assistant United States Attorney Central District of C alifornia

I. Introduction
Wh en the Social Security Administration (SSA) determines that a beneficiary cannot manage his T itle II or Supplemental Security
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Income (SS I) benefits, SSA selects a representative payee, who m ust use the paym ents for the beneficiary's needs and is responsible for receiving and spending benefits on the beneficiary's behalf. The representative payee also has the authority to decide how benefits will be spent on behalf of the beneficiary. About 5.3 million representative payees m anage payments for approximately 6.7 million beneficiaries for all

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of SSA 's Title II program s, while approximately 2.3 million recipients of Title XVI SSI benefits have representative payees. See Testimony of Patrick P. O'Carroll, Jr., Acting Inspector General/SS A, U.S. House Committee O n W ays and M eans, Sub comm ittees on Human Resources, Fra ud and Abuse in the Supplemental Security Income Program , (May 20, 2004 ), available at http://www.ssa.gov/oig/commun ications/ testim ony_speeches/05202004testimony.htm. In managing the representative payee process, SSA strives to provide appropriate safeguards to ensure that the individu als chosen meet their responsibilities to the beneficiaries they serve. See , e.g., SSA's Representative Payee Program: Safeguarding B eneficiaries From Abuse, Hearings Before the Special Committee on Aging, U.S. Senate, 101st. Cong. 1st. Sess., S. Hrg. No. 101-182 (June 6, 1989), Consultant's Report at 78, note 5.

pub lic charity, remains the same. See Dvorak v. Celebrezze , 345 F.2d 894, 897 (10th Cir. 1965). Title II also contains the Act's primary criminal provisions (cited as 42 U.S.C. 408(a)(1)-(8)), which include language that carefully spells out the Act's restraints on representative payee fraud. Specifically, 42 U.S.C. 408(a)(5) provides prosecutors with a felony charge for prosecution of representative payees under the various Title II programs by requiring disclosure of specific events and identification of facts that affect the right to payment and use of benefits by a representative payee on behalf of another.

B. Title XVI Supplemental Security Income (SSI)

Title XVI of the Act, also known as Supplemental Security Income (SSI), was enacted in 1972 as part of Pub. L. No. 92-603, and has been amended by Pub. L. Nos. 7-35, 97-98, 97-123, 97-248, 97-377, and 97-424; 42 U.S.C. 1381-1383c; and 42 U.S.C. 1384-1385. SSI is the first federally administered cash assistance program in the United States made available to the general public. SSI is designed to provide a floor of income for the aged, blind, or disabled who have little or no income and resources. The program establishes that payment may be received as a right by those United States citizens, or legally admitted aliens residing in the United States, who qualify as aged, blind, or disabled, and who meet income and resource criteria. No work credits are necessary for entitlement under the SSI program . Like Title II, Title XVI contains criminal provision s (cited as 42 U.S.C. 1383a(a)(1)-(4)), such as 42 U.S.C. 1383a(a)(4), which can be used to prosecute representative payees under the SSI program for knowingly and willfully converting SSI benefits "to a use other than for the use and benefit of" the SS I recipient.

II. Legislative history A. Title II programs

The Social Security Act (the Act) was enacted as Pub. L. No. 74271, 49 Stat. 620 (1935), and approved on or about August 14, 1935. The A ct has been amend ed, in part, a number of times. SSA was established and approved as an independent agency on or about August 15, 1994, by Pub. L. No. 103296, 101, 108 Stat. 1464 (1995). A Commissioner of Social Security was approved and made responsible for the exercise of all powers and the discharge of all duties of SSA. As a statutory agency, SSA w as given responsibility for administering benefits programs under T itle II (42 U.S .C. 401-434), an d Title XV I (42 U.S.C. 138 1-1383a) of the Social Security Act of 1935 (42 U.S.C. 301-1399 ). Title II of the Act, also known as the Old Age, Survivor's, and Disability Insurance (OAS DI) and Disability Insurance (DI) benefits program s, are primarily responsible for monthly benefits to covered workers who have reached the age of eligibility (sixty-two) and have retired. Since its initial enactment in 1935, the Act has been frequently modified, and has added other types of benefits that protect and cover workers who become severely disabled before reaching retirement age. However, the Act's original purpose, "to ameliorate...the rigors of life," the tragic consequences of old age, disability, loss of earnings power, and dependency on private or
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III. Statutory authority for the representative payee program

The Representative Payee Program, enacted by Congress in 1936, authorized SSA to pay recipients' benefits to a "representative payee," if and when doing so would be in the best interest of the intended beneficiary. See 42 U.S.C. 405(j)(1)(A), 1631(a)(2)(A). A representative
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payee is an individual or organization authorized to receive and manage benefits on behalf of someone deemed incapable of doing so on his own. Specifically, Title II of the Act states: (j) Representative payees If the C ommissioner of Social Security determines that the interest of any individual under this subchapter would be served thereby, certification of payment of such individual's benefit under this title may be made, regardless of the legal competency or incompetency of the individual, either for direct payment to the individual, or for his or her use and benefit, to another individual, or an organization. . . . 42 U .S.C. 405(j)(1)(A). Title XVI 1631(a)(2)(A) of the Act (parallel cite is 42 U.S.C. 1383(a)(1)-(4)) states: (i) Payments of the benefit of any individual may be made to any such individual or to the eligible spouse (if any) of such individual or partly to each. (ii)(I) U pon a determ ination by the [Secretary] that the interest of such individual would be served thereby, such payments shall be made, regardless of the legal competency or incompetency of the individu al or eligible spouse, to another individual, or an organization, with respect to whom the requirements of subparagraph (B) have been met (in this paragraph referred to as such individual's "representative payee") for the use and benefit of the individu al or eligible spouse. (ii)(II) In the case of an individual eligible for benefits under this subchapter by reason of disability, the paym ent of such benefits shall be made to a representative payee if the Comm issioner of Social Security determines that such payment would serve the interest of the individual because the individual also has an alcoholism or drug addiction condition (as determined by the Commissioner) and the individual is incapable of managing such benefits. For parallel cites see 42 U.S.C. 1383(a)(2)(A)(i), 1383(a)(2)(A)(ii)(I), and 1383(a)(2)(A)(ii)(II) resp ectively. The Code of Federal Regulations explains the function of representative payees:
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A representative payee may be either a person or an organization selected by us [the Social Security Administration] to receive benefits on behalf of a beneficiary. A representative payee will be selected if we believe that the interest of a beneficiary will be served by representative payment rather than direct paym ent of benefits. Generally, we appoint a representative payee if we have determined that the beneficiary is not able to manage or direct the m anagement of benefit paymen ts in his or her interest. 20 C .F.R. 404.2001(a).

IV. Qualifications and guidelines for selecting a representative payee

SSA is responsible for appointing, as representative payee, the best qualified party, including an individual, agency, organization, or institution, available and willing to serve as the beneficiary's payee. See SSA Programs and Operations Manual (POMS), GN 0050 2.100(A), GN 00502.130, available at http://policy.ssa.gov/ poms.nsf/poms. Before appointing a representative payee, SSA must find the beneficiary incapable of managing, or directing the m anagement, of his own benefit paymen t. POM S, GN 00502.020. The qualifications and guidelines for the Representative Payee Program are codified in both Title II and Title XVI. SSA has delegated the responsibility of identifying and administering representative payees through a carefully-crafted process designed to select the representative payee best suited to manage the funds of a beneficiary when it is determined that the individual is unab le to manage his own affairs. See 42 U .S.C. 405(j)(1)(A), 1631(a)(2)(A). See also POMS, GN 0050 2.100(A).

A. Beneficiaries who must have a representative payee

SSA has identified certain individuals who, when receiving benefits from any Social Security Title II or Title XVI program, must have a representative payee ap poin ted to manage their funds. T hese individu als include: most child ren under the age of eighteen; legally incompetent adults; and

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anyone determined by SSA to be incapable of managing or directing the management of his fund s.

verify the Social Security account number or employer identification number of the applicant; determine whether the applicant has been convicted of a Social Security felony under either 42 U.S.C. 408 or 1332 (See 42 U.S.C. 408, 1011, or 1383a); and determine whether the applicant has ever been dismissed as a representative payee for misuse of a beneficiary's funds. See 42 U.S.C. 405(j)(2).

See 20 C .F.R. 404.2021.

B. Who may qualify to serve as a representative payee

Generally, SSA w ill approve most app licants who wish to become a representative payee, including the following: someone (other than a convicted felon) who is concern ed with the welfare of the beneficiary, usually a parent, spouse, close relative, guardian , or friend; an institution such as a nu rsing hom e or health care provider; a public or nonprofit agency or financial organization; or providers or administrative officers at hom eless shelters.

See POMS, GN 0050 2.115(A), available at http://policy.ssa.gov/poms.nsf/pom s. During an interview with SSA, prospective representative payees are instructed on their duties and responsibilities, and are required to sign an acknowledgment, under penalty of perjury, that they understan d their obligation to the beneficiary. On ce incapability has been established, SSA will select a representative payee from among interested persons, agencies, or institutions, giving special consideration to whether the proposed representative is in a position to look after the beneficiary's needs. See 20 C.F.R. 404.202; 416.620. The selection of a representative payee is an exercise of discretionary authority; thus SSA has no duty to independently investigate or verify information provided by the potential represen tative payee. See Watson v. Califano, 487 F.Supp . 179 (S.D.N.Y . 1979).

See 20 C .F.R. 404.2021. Moreover, before appointing a representative payee, SSA must evaluate medical or other types of evidence about the recipient's capability of managing his SSA benefits. In deciding whether there is a need for a representative payee, SSA will consider lay, medical, and legal evidence. Lay evidence must be supplied in all cases, and medical evidence must be given whenever possible. Legal evidence is required when there is an allegation of legal incompetency. See 20 C.F.R. 404.2015; POM S, GN 00502.020, available at http://policy.ssa.gov/poms.nsf/pom s. Under both Title II and Title XV I (SSI) programs, an applicant for selection as a representative payee must disclose to SSA his relationship to, or responsibility for, the care of the beneficiary before any funds will be paid. See 20 C.F.R. 404.2025(a) (Title II); 20 C.F.R. 416.62 5(a) (Title XVI). This is accomplished by completing an application on Form SSA-11-BK to serve as payee. Form SSA-11-BK must be completed in a face-to-face interview . During the interview of a representative payee ap plicant, SSA must: requ ire the representative payee ap plicant to subm it documented proof of identity;

C. Limits and restrictions on a representative payee

SSA places limits on what representative payees can do once they are selected to manage the affairs of a beneficiary. The duties and obligations of a representative payee to h is beneficiary are recognized by SSA as lawful on ly for benefits paid by SSA on behalf of the beneficiary. A representative payee only has the legal authority to decide how the Social Security and/or SSI payment will be used for the beneficiary's care and well-being. Thus, a representative payee is not legally authorized by SSA to: use a beneficiary's money for anything other than the beneficiary's needs; spend a beneficiary's funds in a way that would leave him or her without necessary

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items or services (housing, food, clothing, medical care); put a beneficiary's Social Security and/or SSI paym ents in his or another person's account; use a beneficiary's "dedicated account" funds for purposes not related to the child's impairment (for example, medical treatm ent, education, job skills training, etc.); keep the beneficiary's conserved funds if he is no longer the representative payee; charge the beneficiary for services unless authorized by SSA ; make m edical decisions; sign legal documents, other than Social Security docum ents, on behalf of a beneficiary; and have legal authority over earned income, pensions, or any income from sources other than Social Security and/or SSI payments.

represen tative payee serves in a fiduciary relationship with the beneficiary and must administer the benefits in the beneficiary's best interest. The representative payee is required to provide SSA with a simple accounting (usually on an annual basis) and a description of how he spent the money. Specifically, the representative payee must keep accurate written records of all payments received from SSA and how they were spent and/or saved. The representative payee must save any money left after meeting the beneficiary's current needs in an interest bearing account or in United States savings bonds. The representative payee must respond, on the beneficiary's behalf, to any SSA requests for action or information. Comm on requests are for the annual representative payee accounting, the SSI redetermination of eligibility, or a continuing disability review. Complete written reports accounting for the use of funds and assisting the beneficiary in the completion of contin uing disability review s and redeterminations of eligibility may also be required. Representative payees must return any payments to which the beneficiary is not entitled to SSA. Th ey must also be aware of any other income or funds the S SI beneficiary has. This is important because other income and/or other resources may impact the beneficiary's SSI eligibility and/or payments. The representative payee is responsible for reporting to SSA any change in circumstances that could affect the recipient's eligibility (e.g., income, resources, change of address, living arrangements, return to work, etc.). They mu st also report any changes or events which could affect the beneficiary's eligibility for benefits or payment amount, such as a change in the amount of a pension, wage changes (number of hours worked or hourly wage change), etc. Representative payees must return any conserved funds to SSA, if the representative payee stops serving the beneficiary.

See POMS, GN 0060 2.130.

D. Duties and responsibilities of the representative payee

SSA requires that an individual assume several duties and obligations on behalf of a beneficiary when appointed as representative payee. The most important du ty of a representative payee is to know the needs of the beneficiary and to use the benefits in the best interests of the beneficiary. See 20 C.F.R. 404.2035. The representative payee must use SSA benefits for the current basic needs of the beneficiary, such as food, clothing, an d shelter. See 42 U.S.C. 405(j), 1383(a)(2) (2002). SSA regulations define "for the use and benefit" of the recipient to include costs of current maintenance, 20 C.F.R. 404.2040(a)(1), and define "current maintenance" to include custom ary ch arges by a state, federal, or private institution where the beneficiary is receiving care. See 20 C.F.R. 404.2040(b). In addition to the basic duties and responsibilities of the representative payee, SSA requires the following: After the appointment of a representative payee, SS A b enefits paymen ts are mailed to the payee and are to be put in a bank account specifically designated as a payee account. No commingling of beneficiary funds and represen tative payee funds is allowed. A

See 20 C.F.R. 404.2035.

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V. Prosecuting representative payees A. Representative payee penalties for violation of Title II and Title XVI
The Social Security Act prescribes criminal penalties for violation of its provisions concerning fraud, disclosure of certain information, and represen tation. See 42 U.S.C. 408(a)(5) and 1383a(a)(4). The purpose of the Act's criminal provisions is to protect S ocial Security beneficiaries and the general public, as well as governmental interests, by maintaining the integrity of the claims process and the T rust Funds. Representative payee fraud can also be the result of omission when a beneficiary, or his representative payee, fails to report a change in circumstance, such as a marriage, a new source of income, incarceration, removal from custodial care, or the death of a parent or spouse, while continuing to spend checks or direct deposits by SSA . Violations by a representative payee that could result in criminal prosecution for Social Security fraud include: forging or falsifying Social Security Administration (the Agency or SSA) docum ents; conspiring to obtain or allow a false, fictitious, or fraudulent claim; making or causing to be made a false statement or representation of a material fact for use in determining rights to Social Security benefits; making or causing to be made any false statement or representation of a material fact in any application for any payment or for a disability determination under the Social Security Act; concealing or failing to report any event affectin g the initial or continued right to payment received or to be received by a person individually or on behalf of another; and converting all or any part of a payment received on beh alf of a beneficiary to a use other than for the use and benefit of that beneficiary.

was unsuccessful and SSA did not make a payment as a result. The penalty upon conviction for violation of the criminal provisions of Title II and Title XVI of the Act may be a fine ($250,000), imprisonment (five years), or both. See 42 U.S.C. 408(a)(1)-(8) and 1383a(a) (1)-(4).

B. 42 U.S.C. 408(a)(5)
Criminal liability under 42 U.S.C. 408(a)(5) arises if an individ ual know ingly and willfully converts to an unauthorized use, a benefit that he has accepted as payee on another's behalf. For exam ple, a criminal violation occurs if a defendant applies (a formal application to become representative payee is required by SSA) to become representative payee for the use and benefit of an other and, having received payments of a benefit from SSA on behalf of another, knowingly and willfully converts the paym ents to his own use rather than for the use, and benefit of the intended beneficiary. A comm on violation occurs wh en a representative payee intentionally conceals the death of another in order to continue to receive and spend the benefits payments made by SSA to the representative payee. A fiduciary relationship exists between beneficiary and representative payee. If a representative payee misuses benefits, the representative payee may be removed by SSA. 42 U.S.C. 405(j)(1)(A ) and 1383(a)(2)(A)(iii). Moreover, a representative payee's misuse of the beneficiary's funds is a felony. 42 U.S.C. 408(a)(5). Given the criminal penalty for misuse of funds, som e courts have inferred a fiduciary relationship between beneficiary and representative payee, although the statute and implementing regulations do not provide for such a relationship. See Garvey v. Worcester Housing Auth., 629 F.2d 691 (1st Cir.1980); Bradley v. Austin, 841 F.2d 1288 (6th Cir.19 88).

C. Examples of representative payee fraud

The following demonstrate actual scenarios of representative payee fraud (only the names have been changed to protect the guilty): John Boyee has been declared to be legally incompetent and lives alone in an apartm ent. H e is a daily visitor to th e Los Francisco Community Services (LFCS) agency, which provides limited case management and a free lunch program. The
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See 42 U .S.C. 408(a)(1)-(8), 1383a(a)(1)-(4). A representative payee may also be sub ject to criminal prosecution even if the attempted fraud
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LFC S staff interacts with Boyee on a daily basis, and can determine his current needs, pay his rent, and assist him with obtaining medical treatm ent. LFCS applied for and was appointed representative payee for Boyee, and began receiving his monthly benefits payments. LFCS discovered that its management of Boyee's affairs was so efficient that m ore than half of his monthly SSA benefits payment was unused. As representative payee, LFC S was required to conserve any money left at the end of the month for the sole use and benefit of Boyee. Instead of conserving Boyee's remaining benefits at the end of the month, LFCS cooked their books, pocketed the extra cash each month, and submitted annual representative payee reports in which they made misrepresentations as to the management of Boyee's affairs. Jack Baybee and his grandmother, Granny, live together in a house rented from HUD . Granny is eighty-four years old and suffers from diabetes and advanced cataracts. Grann y is unable to walk without substantial aid and is legally blind. Baybee is Granny's representative payee for her Title II S urvivor's benefits. Baybee pays G rann y's bills, takes care of the house, monitors G rann y's medical bills, and takes Granny to church twice each S und ay. Granny died in 1992. H owever, Baybee, despite his obligation as a representative payee to report Granny's death, failed to do so. Instead, Baybee continued to receive G rann y's Title II Survivor's benefits each month and use them for gambling, drugs, and rock-n-roll. Baybee continued to make annual reports to SSA detailing his fictitious administration of dead G rann y's affairs. Suzie Gurl is a self-described crack queen, who lives in a week-to-week motel and has a livein biker boyfriend who keeps her drug habit well stocked. Gurl has three children under the age of twelve, and one minor child aged sixteen, all of whom have been adjudged as learning disabled, and each of whom has received Title XVI SSI and Title II Survivor's benefits for more than four years. The three children under age twelve were removed from Gurl's custody by State Children's Services for neglect and placed with foster families, and the sixteen-year-old has been incarcerated in a state juvenile facility for three years for sexually abusing his younger siblings. Despite her obligation as a representative payee to do so, Gurl did not notify SSA that her three youngest kids were removed from her care or that

the sixteen-year-old had been incarcerated. Instead, Gurl kept quiet and continued to receive SSI and Survivor's benefits payments, which she used to buy drugs. Johnny B. B aad (JB), age sixteen, collects Title XVI SSI benefits based on a learning disability and receives Title II Survivor's benefits based on the SSA account of his deceased father, Daddy Sugar. Mae Sugar, JB's mom, has been JB's representative payee since he first began receiving SSA Survivor's benefits when he was twelve months old. Mae Sugar lied to SSA when she applied for JB's Survivor's benefits after the death of Daddy Sugar. JB was not the son of Daddy Sugar, a fact known to Mae and Daddy Sugar, before his death. Mae conceived JB during a two year period just before Daddy's death, when Mae and Daddy were separated. Daddy never acknowledged JB as his child, and had gone so far as to get a blood test just before his death in order to put his affairs in order and to confirm that he was not JB's father. After Daddy's death, Sugar applied for benefits, claim ing that JB was Daddy's son. JB received Survivor's benefits based on Daddy Sugar's accou nt for twelve years before Mae's current boyfriend spilled the beans and notified SSA of the fraud.

D. Using Title 18 to charge representative payees

Most representative payee fraud cases are, by their very nature, crimes of opportunity involving theft of benefits payments or false or fraudulent statements made in m atters before an agency. Thus, in addition to violations of the felony fraud provisions of the Social Security Act, almost any representative payee crime can be charged under Title 18 as theft of government property (18 U.S.C. 64 1) and/or false statement to a government agency (18 U.S.C. 1001). The elements required to prove a violation of Title 18 U.S .C. 641 are that: the defendant stole money with the intention of depriving the owner of the use or benefit of the money; the money belonged to the United States; and the value of the money was more than $1,000.

In some instances, it can be advantageous for a prosecutor to ch arge a representative payee with theft of government property (18 U.S.C. 641),
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which d oes not require a finding of fraud as a necessary element. This might be true even though, under the facts of the case, the prosecutor could not charge the case under the Social Security felony fraud statute (where fraud is a necessary element). Social Security benefit funds, whether tendered by check or deposited autom atically by electronic wire transfer, are considered "property" and "a thing of value of the United States" within the meaning of 18 U.S.C. 641. United States v. Spear, 734 F.2d 1, 2 (8th Cir. 1984); United States v. Torres Santiago, 729 F.2d 38, 40 (1st C ir. 1984). See also United States v. How ard , 787 F. Supp. 769, 771 (S.D . Oh io 1992); United States v. Walker, 563 F. Supp. 805, 809-10 (S.D. Iowa 1983); United States v. Edwards , 473 F. Su pp. 81 (D. Mass. 1979). The elements required to prove a violation of Title 18 U.S.C. 1001 are: the defendant made a false statement; the defendant acted wilfully, that is deliberately and with the knowledge that the statement was untrue; the defendant made the false statement to a governmental agency; and the defendant's statement was material to the agencies' activities and decisions.

of 18 U.S.C. 1001 are satisfied if the governm ent proves one of the follow ing: that the statement was capable of having some nontrivial effect on the agency. United States v. Facchini, 874 F.2d 638 (9th C ir. 1989); or that the agency had the power to act on the statemen t. Ogden v. United States, 303 F.2d 724 , 742-43 (9th Cir. 1964); or that there was actual or constructive know ledge of the federal relationship. Gilbert v. United States, 359 F.2d 285, 287 (9th C ir. 196 6); or that there is a relationship between the act and the federal govern ment. Ebeling v. United States, 248 F.2d 429, 434 (8th Cir. 19 57).

To prosecute a representative payee for Social Security frau d, the prosecutor is only required to prove that the statement is "false" in one material aspect. Cohen v. United States, 201 F.2d 386, 393 (9th Cir. 1953). While SSA representative payees are alm ost always aware of their false statement, actual kn owledge of the falsity is not always required. United States v. Sarantos, 455 F.2d 877, 880 (2d Cir. 1972); United States v. Egenberg , 441 F.2d 441, 444 (2d Cir. 1971). A conviction for making false statements or concealment also requires a show ing of materiality. A statement is m aterial if it could reasonably affect or influence the exercise of a governmental function. United States v. Facchini, 874 F.2d 638, 643 (9th Cir. 1989); United States v. Radetsky, 535 F.2d 556, 571-72 (10th C ir. 1976); United States v. Deep , 497 F.2d 1316, 1321 (9th Cir. 1974); United States v. Ratner, 464 F.2d 101, 103 (9th Cir. 1972). Representative payee false statements are always material if they are included on SSA documents affecting the initial, or continued right, of a beneficiary to receive benefits. Similarly, the ju risdictional requirements
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All of these jurisdictional elements are typically found in representative fraud cases. Interestingly, SSA need not have actually relied on the information for it to be material, United States v. Myers , 878 F.2d 1142, 1143 (9th Cir. 1989), and it is not necessary that the government be deceived or suffer monetary loss, United States v. Jones, 464 F.2d 1118, 1121-22 (8th Cir. 197 2). It is not necessary that a false statement was made directly to an officer or agent of the U nited States. United States v. Green, 745 F.2d 1205, 1208 (9th Cir. 1985); Un ited States v. Wolf , 645 F.2d 23, 25 (10th Cir. 1981). The governm ent need not prove that a defendant had "jurisdiction al know ledge" (i.e., that defendant knew that his statements were made to, or available to, a government agency). United States v. Oren, 893 F.2d 1057, 1065 (9th Cir. 1990); United States v. Yermian , 468 U.S. 63, 74-75 (1984); United States v. Green, 745 F.2d 120 5, 1209 (9th Cir. 1985).

VI. Sample indictments

The following are sample indictment language charging representative payees under Title 42 and Title 18: COU NT ____ [42 U .S.C. 408(a)(5)] Beginning in or around May 1992, and continuing without interruption until in or around January 2000, in Santa Barbara County, within the Central District of California, defendant
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_____________, having made application to receive paym ent of Social Security child's insurance benefits payments for the use and benefit of another and having received such payments, knowingly and willfully converted such payments to a use other than for the use and benefit of such other person. Specifically, while acting as Representative Payee for her step-son, __________, defendant ______________ converted to her own use Social Security child's insurance benefits payments made to her on behalf of ________ _, and by such action obtained approximately $116,083 in child's insurance benefits payments to which she knew that she was not entitled. COU NT _____ [42 U .S.C. 1383a(a)(4)] Beginning in or around April 1999, and continuing without interruption until in or around Sep tember 1999, in Los An geles County, within the Central District of California, defendant ___________, aka __________, in a m atter within the jurisdiction of the Social Security Ad ministration, having m ade application to receive Supplemental Security Income Benefits payments as Representative Payee for the use and benefit of her son, _______________, and having received such benefits payments, knowingly and willfully converted the benefits payments for her own use rather than for the use and benefit of her son. Specifically, defendant _______________, while acting as Representative Payee for her son, _____________, failed to disclose ______'s death in order to continue to receive and spend Supplemental Security Income Benefits paymen ts paid to _________ by the Social Security Administration. By such action, defendant ______________ stole ap proximately $4 3,474 in Supplemental Security Income Benefits paymen ts to which she knew that she was not entitled. COU NT ___ [18 U.S.C. 641] Beginning in or around June 1999, and continuing without interruption until in or around Sep tember 2003, in Los An geles County, within the Central District of California, defendant ______________ did knowingly embezzle, steal, and convert to her own use money of the Social Security Administration, an agency of the
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Un ited States, namely, Social Security Supplemental Security Income Benefits paymen ts paid to her as Representative Payee for _____ _____ ____ to which she knew that she was not entitled, having a value of approximately $61 ,431. COU NT ____ [18 U.S.C. 1001] On or about August 29, 2003, in Los An geles County, within the Central District of California, defendant _________, in a matter within the jurisdiction of the Executive Branch of the Government of the United States, knowingly and willfully made a materially false, fictitious, and fraudulent statement and representation. Specifically, on a Statement for Determining Continuing Eligibility for SSI Payments (SSA Form 8203-BK), dated August 29, 2003, defendant _______ falsely answered "no" to question #4, which asked: "have you (or your spouse living with you) earned money from work?" In truth and in fact, as defendant _______ well knew, at the time he completed the SSA Form he had earned money from his full-time work as a _______ while using his son's social security number (XX X-X X-X XX X).

VII. Conclusion
Representative payee fraud is a serious problem within SSA benefits programs. Hundreds of needy beneficiaries are abused and millions of dollars are lost each year from fraud perpetrated by SSA appointed fiduciaries who abandon their responsibilities or use their position to steal from those payees who are most vulnerable and in need of help. Prosecution of representative payee fraud remains an important priority for the SSA and the United States Attorneys' offices. ABOUT THE AUTHOR

John Webb is a Senior Attorney with the

Office of Chief Coun sel for the Inspector G eneral, Social Security Administration, and a Special Assistant United States Attorney with the United States Attorneys Office for the Central District of California, Los Angeles, where he serves as the Iden tity Theft Coordinator. He is responsible for prosecuting federal crimes

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involving identity fraud and abuse of Social Security programs, and has participated in the indictment and prosecution of individuals related to the terror attacks of 9/11, as well as the planning and implementation of Operation Tarmac/Operation Safe Harbor in Phoenix and Los Angeles. Mr. Webb has served as an instructor at the National Advocacy Center on the topics of identity theft, Social Security number misu se, and Federal Benefits Fraud. Mr. Webb is a regular contributor to the United States Attorneys' Bulletin .a

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