Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.
By Dan King
If the investigator compares “Appendix C” and determines that the group numbers have not been issued or are out of sequence, what recourse does he have?
Actually, he’s only taken the first step in a somewhat lengthy process. The second step is to contact the local Social Security Administration Office (SSA) to certify the initial findings. The local SSA will verify – the issuance of the number or they will advise whether the specific person about whom the investigator is inquiring was issued that number. They will not divulge the true number (should it be different) issued to the person about whom the inquiry is being made — nor will they divulge the identity of the true number holder.
If this is accomplished via telephone, the conversation may go something like this:
Investigator: Is John Doe the valid holder of social security number 123-45-6789?
SSN clerk: 123-45-6789 is not assigned to a person with the name John Doe.
Investigator: Who is that number assigned to?
SSN clerk: I’m sorry but I’m not at liberty to release that information to you.
Investigator: Well then, can you tell me what John Doe’s actual number is?
SSN clerk: Not on your life, honey.
Investigator: What are you doing at 5 o’clock? I’ll buy you a drink at Flagpole Fred’s Bar and Grille and then…
Click.
The SSA request should include the name, date of birth, address and any numbers attributed to the inquiry. If all that is available is name and social security number, it will suffice. The letter should include a statement that the disclosure is being requested pursuant to the Freedom of Information Act.
Upon receiving the answer from SSA, which will typically take four to six weeks, the next step is to determine jurisdiction. The criteria varies widely between Federal and State statutes, so consultation will be necessary.
Beverly Carter, investigator for the Houston area SSA, advises that when there has been a significant dollar loss to the government, the SSA uses US Code, Title 42, Section 408. This section deals specifically with social security number misrepresentations. When there is a smaller dollar loss, the SSA may present such cases to the local District Attorney’s office to be prosecuted under local statutes. Depending on circumstances, the SSA’s investigators are first committed to cases directly impacting SSA Program Benefits, but they may have joint interests involving other misuse of SSNs.
In cases of insurance fraud involving an organized group or ring, the Secret Service may be a better choice for assistance. David Bentz of the Secret Service is the coordinator for the group of local, state and federal law enforcement agencies working alien fraud rings. Bentz’s group is responsible for the North Texas area, but he advises that these task forces are strategically located throughout the USA. More information can be obtained by contacting the local Secret Service office.
The Secret Service is seeking assistance from the insurance company. Bentz advises they have had successful prosecutions using the US Codes.
In California, Penal Code Section 532 has been used successfully. In Texas, Penal Code 37.10 (Tampering with Government Records) applies and is a felony.
Oklahoma has more specific sections, depending on the type of insurance fraud involved. In workers’ compensation, social security number fraud is prosecuted via comp law Title 21, Section 1663, Subsection C-I and 3. Many other states have used similar statutes with success. Investigators are therefore urged to research the applicable statutes in each state they work in and ascertain what will apply in each specific locale.
The fraudulent use of Social Security numbers is a continuing, if not worsening, problem. Rather than allow the problem to persist, the insurance industry may need to pursue legislative reform concerning the
abuse of Social Security numbers. By creat ing codified law that directly addresses Social Security number violations and prescribes substantial deterrents at the state level, an aid to control may be provided.
By simply understanding SSA rules and procedures, the investigator will be able to incorporate questions into claimant interview statements that may aid in the prosecution of Social Security number fraud.
Examples:
Did you obtain your card at an SSA office?
Which office?
By application or by interview?
By whom (description)?
Was a form used? (SS-5 required for application) Did you present documentation of I.D.?
What type? (INS Green Card, birth certificate, student visa, etc.)
When did you receive your number?
How was it presented (additional paperwork)?
Were other numbers applied for or used?
And so on, depending on circumstances.
There is a manual available for those who would like more information on the SSA. It can be obtained by sending a request to:
Policy Coordination on Instruction Staff HHS/OIG/OI
PO Box 17303
Baltimore, MD 21203
(410) 965-9757
Fax (410) 966-7075