Disability fraud
Encyclopedia
Disability fraud is the receipt of payment(s) intended for the disabled from a government agency or private insurance company
by one who should not be receiving them or the receipt of a higher amount than one who is entitled to them should be receiving. There are various acts that may constitute disability fraud. These include feigning a medical problem in order to be declared disabled
, exaggeration of an existing medical problem that potentially can but in reality does not render the person disabled, continuing to receive payments after having recovered from a medical problem, or continuing to receive payments while working (usually unreported
) above the allowable level for those receiving the payments.
Disability fraud can be harder to detect than other forms of fraud, as the majority of people receiving disability payments (at least 90%) do not use a wheelchair or walker, while at the same time, many people who need wheelchairs would not qualify for disability payments. Since most disabilities are "silent" (meaning that they cannot be seen by others), it is not easy to visually determine if a person receiving disability is not disabled. Such people are often able to perform physical activities, but have some other underlying cause of their disability. It is therefore common for people to believe they must report a neighbor who they see, for example, climbing on the roof while collecting disability payments. But this is not always the case.
Meanwhile, true disability fraud cases exist, for which it is hard to determine the cause as being fraudulent. Often, the perpetrator claims to have a medical condition to be declared disabled. Some medical conditions are truly debilitating and make it impossible or difficult to work if one has them, but are hard to prove against one's own word that one does not have them. These include chronic fatigue syndrome
, chronic pain
, or various mental disorders. Even if one with one of them is viewed engaging in some other "work-like" activity not for pay, they may have difficulty holding a job.
It is possible that the illegal recipient of the disability payments is not truly disabled, and may have a case of work aversion
, which in many countries is not alone considered a valid reason for being declared disabled, or the person may otherwise lack a work ethic
. Others who are receiving payments are actually working, but are not reporting their employment and collecting their income in a manner that cannot easily be detected.
Disability fraud can result in denial of future benefits as well as criminal prosecution.
Social Security Administration
accepts reports from the public for the following types of fraud:
The Social Security Administration does not accept reports from callers who think that a person receiving benefits does not "appear" disabled.
Disability insurance
Disability Insurance, often called DI or disability income insurance, is a form of insurance that insures the beneficiary's earned income against the risk that a disability will make working uncomfortable , painful , or impossible...
by one who should not be receiving them or the receipt of a higher amount than one who is entitled to them should be receiving. There are various acts that may constitute disability fraud. These include feigning a medical problem in order to be declared disabled
Disability Determination Services
Disability Determination Services, commonly called DDS, are state agencies, funded by the United States Federal Government. Their purpose is to make disability findings for the Social Security Administration....
, exaggeration of an existing medical problem that potentially can but in reality does not render the person disabled, continuing to receive payments after having recovered from a medical problem, or continuing to receive payments while working (usually unreported
Unreported employment
Unreported employment, often referred to colloquially as working or being paid under the table or cash-in-hand, is employment that is not reported as required by law to the appropriate local, state or provincial, or national government agency. This is often done by the employer or the employee in...
) above the allowable level for those receiving the payments.
Disability fraud can be harder to detect than other forms of fraud, as the majority of people receiving disability payments (at least 90%) do not use a wheelchair or walker, while at the same time, many people who need wheelchairs would not qualify for disability payments. Since most disabilities are "silent" (meaning that they cannot be seen by others), it is not easy to visually determine if a person receiving disability is not disabled. Such people are often able to perform physical activities, but have some other underlying cause of their disability. It is therefore common for people to believe they must report a neighbor who they see, for example, climbing on the roof while collecting disability payments. But this is not always the case.
Meanwhile, true disability fraud cases exist, for which it is hard to determine the cause as being fraudulent. Often, the perpetrator claims to have a medical condition to be declared disabled. Some medical conditions are truly debilitating and make it impossible or difficult to work if one has them, but are hard to prove against one's own word that one does not have them. These include chronic fatigue syndrome
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...
, chronic pain
Chronic pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...
, or various mental disorders. Even if one with one of them is viewed engaging in some other "work-like" activity not for pay, they may have difficulty holding a job.
It is possible that the illegal recipient of the disability payments is not truly disabled, and may have a case of work aversion
Work aversion
Work aversion is the state of being turned off by working or being employed, or the extreme preference of leisure as opposed to work. It can be attributed to laziness, boredom, or burnout, most underachievers suffer from some work aversion.-Causes:Work aversion usually occurs in persons who have...
, which in many countries is not alone considered a valid reason for being declared disabled, or the person may otherwise lack a work ethic
Work ethic
Work ethic is a set of values based on hard work and diligence. It is also a belief in the moral benefit of work and its ability to enhance character. An example would be the Protestant work ethic...
. Others who are receiving payments are actually working, but are not reporting their employment and collecting their income in a manner that cannot easily be detected.
Disability fraud can result in denial of future benefits as well as criminal prosecution.
Types of fraud
The United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
Social Security Administration
Social Security Administration
The United States Social Security Administration is an independent agency of the United States federal government that administers Social Security, a social insurance program consisting of retirement, disability, and survivors' benefits...
accepts reports from the public for the following types of fraud:
- Applicants who state they are not married when they are. Those receiving Supplemental Security IncomeSupplemental Security IncomeSupplemental Security Income is a United States government program that provides stipends to low-income people who are either aged , blind, or disabled. Although administered by the Social Security Administration, SSI is funded from the U.S. Treasury general funds, not the Social Security trust fund...
(SSI) can have their benefits reduced by their spouse's income and assets, so some applicants may wish to hide the existence, income, or assets or their spouse. - Claims of blindness. In particular, the Social Security Administration is concerned about those who declare they are blind and unable to drive, but are later found to be in possession of a driver's licenseDriver's licenseA driver's license/licence , or driving licence is an official document which states that a person may operate a motorized vehicle, such as a motorcycle, car, truck or a bus, on a public roadway. Most U.S...
and are observed (legally) operating a motor vehicle. - Unreported income. Some types of income that often go unreported are from renting out a portion of one's home, or from an insurance policy.
- Employment changes, in a person who was not working at the time they applied for and started to receive benefits, but has since returned to work.
- A person who is living in an institution, such as a long-term care facility or a prisonPrisonA prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...
- A person who is the legal custodian (representative payeeRepresentative payeeA representative payee, or substitute payee, is a person who acts as the receiver of Social Security Disability or Supplemental Security Income for a person who is not fully capable of managing their own benefits, i.e. cannot be their own payee. The need for the service is generally due to some...
) of a disabled person's money spending it on some expense other than that of the disabled person - A person who cashes the checks of a deceased person
The Social Security Administration does not accept reports from callers who think that a person receiving benefits does not "appear" disabled.
Notable cases
- In 2006, a Massachusetts man was convicted of receiving more than $55,000 in disability payments while continuing to work at his bar. Antonios Sarantos, then 43, of Plymouth, Massachusetts, purchased and opened the T.J. Gupeez bar in TauntonTaunton, MassachusettsTaunton is a city in Bristol County, Massachusetts, United States. It is the seat of Bristol County and the hub of the Greater Taunton Area. The city is located south of Boston, east of Providence, north of Fall River and west of Plymouth. The City of Taunton is situated on the Taunton River...
, then purportedly injured his back working at the prison, several weeks later. Undercover officers reported witnessing Sarantos working in the bar, even as he contended he was too injured to return to prison work.
As of 2009, Sarantos was still working at the Taunton bar, by then renamed Miss Cues (or Miss Ques). During a July 2009 brawl at the bar, Sarantos was arrested for assault and battery on a police officer and disorderly conduct. It was later revealed that while Sarantos maintained ownership of the real estate property, Sarantos had transferred ownership of the club and the T.J. Gupeez Inc. corporate entity to Leighanne Drewniak, a worker at the bar. An officer stated that this was because Santos had a felony conviction that precludes him from owning the full liquor license. As of August 2009, the club's billiards license was in jeopardy.
- In 2007, a UK woman was convicted of more than £11,000 in disability fraud after she claimed she could walk only four meters in five minutes, but continued to work at a job she previously held sweeping horse stables.
- In 2009, an Idaho man pleaded guilty to $1.5 million in disability fraud, the largest such case in the history of the Veterans Affairs DepartmentUnited States Department of Veterans AffairsThe United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
.
- In October 2011, a woman and three accomplices were arrested for, among other serious criminal allegations, collecting SSI benefits from four, and possibly more, mentally disabled adults, as their representative payeeRepresentative payeeA representative payee, or substitute payee, is a person who acts as the receiver of Social Security Disability or Supplemental Security Income for a person who is not fully capable of managing their own benefits, i.e. cannot be their own payee. The need for the service is generally due to some...
, and not using the money towards their well being. The case is under investigation by the FBI and Philadelphia law enforcement.
See also
- Welfare fraudWelfare fraudWelfare fraud refers to various intentional misuses of state welfare systems by withholding information or giving false or inaccurate information. This may be done in small, uncoordinated efforts, or in larger, organized criminal rings...
- Benefit fraudBenefit fraudBenefit fraud is a form of welfare fraud as found within the system of government benefits paid to individuals by the UK welfare state.- What is benefit fraud? :...
- AnosognosiaAnosognosiaAnosognosia /æˌnɒsɒgˈnəʊsɪə/ is a condition in which a person who suffers disability seems unaware of the existence of his or her disability. Unlike denial, which is a defense mechanism, anosognosia is rooted in physiology...
for when the opposite happens and a person with a disability denies that they have one. - Criticisms of welfareCriticisms of welfareThe notion, and the extent of, the modern welfare state has been criticised on both economic and social grounds, from both the Left and the Right of the political spectrum.- Libertarian & Conservative criticisms :...