How to Report Fraud?

[kellyg403]

I guess I have to say something since my dh is suffering from back problems right now, going on a yr.

He may look fine however he is not fine. Unless you have access to his medical files, I cannot see making a judgement on the condition of his back based on what you see.

Just because he is doing these things, doesn't mean he SHOULD BE doing these things. YMMV, I just had to throw my 2 cents in.

I agree with this. I know someone who has fybromyalgia (sp). She has been on SS disability for about 5 years now. Her situation is so debilitating sometimes. Not all the time. Sometimes she is not in pain, not experiencing migraines etc. Those are the times you see her in the yard playing with her grandkids. On the surface she looks totally normal. Our dd's went to school together, were in marching band together. Sometimes, she would be writhing in pain in the back seat on the way home before she could take her pain meds. She didn't like to take them when she was going somewhere that involved her full mental capacity or to be there for her dd. Neighbors who didn't know her situation, but would see her on one of her good days playing in the yard with her grandkids would always make comments.

I guess the moral of the story is that not being a dr and not knowing what the medical file holds, I don't know that I could fairly make an assumption. I do know my friend has to be recertified every so often and I do believe it is with a dr mandated with Social Security or has some affiliation. I would imagine at some point if he is faking it some dr along the way will figure it out. The problem with pain is that it comes and goes and the good days are far fewer than the bad.

I hope your relative isn't faking it. I sure hate that whole idea. But if you are privy to information that leads you to believe that it is fraud then yes, you should report him to the insurance company. Knowing full well there are consequences.

Kelly

 

[PixieTopaz]

Fast forward 3 yrs and "Bill" is no longer working and was awarded permanent disability recently through social security ?

I know someone similar to your "Bill"
Purposely did the opposite of what the Doctor recommended for his back pain-like laid in bed 24/7 instead of doing the exercises prescribed. He is on disability and major pain meds and his life is a misery.

But I wouldnt report him-his life has become his punishment

 

[agnes!]

It might be just me, but I wouldn't turn a relative in. It'd be no skin off my nose that he was collecting SS benefits or insurance money, so I wouldn't want the bad karma.

I would feel jinxed forever if I did what the OP wants to do.

Bad karma?!? How about the bad karma if you have knowledge that "Bill" is probably/possibly committing fraud and you do nothing about it? In my mind it's the same as standing by and allowing someone to break into a house and steal from it, time and time again. Bill is possibly stealing from *me* and *you* and everyone else who lives in the United States, it sounds like he is taking funds and support from those who need it for his own selfish purposes. I'd like to point out that the OP knows the person in question very well, she is not a casual observer of a parking-space issue and she is actually not jumping to any conclusions, she is merely asking how (if she decides to do so) *how* she could report the possible fraud.

Hey, I'm thinking that if Bill is doing nothing wrong, there should be no harm, no foul right? The proper authorities might investigate (or they could even decide *not* to) and they'll find the truth...and I don't think the truth engenders the so-called 'bad karma'.

agnes!

 

[JerseyJanice]

Bad karma?!? How about the bad karma if you have knowledge that "Bill" is probably/possibly committing fraud and you do nothing about it? In my mind it's the same as standing by and allowing someone to break into a house and steal from it, time and time again. Bill is possibly stealing from *me* and *you* and everyone else who lives in the United States, it sounds like he is taking funds and support from those who need it for his own selfish purposes. I'd like to point out that the OP knows the person in question very well, she is not a casual observer of a parking-space issue and she is actually not jumping to any conclusions, she is merely asking how (if she decides to do so) *how* she could report the possible fraud.

Hey, I'm thinking that if Bill is doing nothing wrong, there should be no harm, no foul right? The proper authorities might investigate (or they could even decide *not* to) and they'll find the truth...and I don't think the truth engenders the so-called 'bad karma'.

agnes!

You and I and probably the OP don't know the exact grounds that the benefits were based on. SSI is not easy to get.

To make a judgement that this person should not have been granted benefits is playing God IMO. Trying to turn him could ruin his life; I wouldn't do something like that lightly.

 

[Disney Doll]

Doesn't reporting suspected fraud mean that the SS administration will go out and investigate and they determine if it is truly fraud??? So, all of these variables that people are bringing up...maybe he doesn't have back pain all the time, maybe he doing things against the MD's advice etc...will all be things that would be part of the information that the investigation elicits and will be used to make their determination as to whether or not he is being fraudulent.

 

[DVC-Don]

They'll look into it on their own, so it's not just your experience with "Bill" they'll consider. Back in my insurance adjuster days I quite often hired private investigators to observe someone. Quite a few times the PI would come back with a recording of the claimnant pouring house foundations of something like that. Then I'd call their attorney and offer to let them view the recording. Every time I did that, the claim would go away. On the other side, some were quite legit.

 

[AKL_Megs]

Can you get someone to sneak a photo of Bill playing horseshoes or chucking wood?

I am sure the insurance company would LOVE a picture of that!

 

[Tinker'n'Fun]

In NYS on SSD your account is reviewed approximately one year after the first decision, three years after the 2nd. review, and approximately every 5 years after that.

The amount of documentation needed from physicians is mind-numbing. The SSD office also requires at least one visit to their drs. Sometimes many more.

If you do report the fraud and they "hold" his income, aren't you also hurting your sister and any children in the family? I am definetely against fraud of any sort, but sometimes just reasoning out how someone may have gotten the benefit, totally outways the chances that they are scamming the system. I don't have specifics, but I did read a while back that the actual numbers of people who scam the system are actually quite low. It's just that it gets more press than those who use the system properly.

OP sorry you have to make such a hard choice. May you find peace in your final decision.

 

[agnes!]

You and I and probably the OP don't know the exact grounds that the benefits were based on. SSI is not easy to get.

To make a judgement that this person should not have been granted benefits is playing God IMO. Trying to turn him could ruin his life; I wouldn't do something like that lightly.

It sounds like the OP isn't doing it 'lightly'...as a matter of fact she has not done it at all yet...otherwise she would have come on here, guns blazing and posted about how she already turned in someone for insurance/etc. fraud.

agnes!

 

[JerseyJanice]

Doesn't reporting suspected fraud mean that the SS administration will go out and investigate and they determine if it is truly fraud??? So, all of these variables that people are bringing up...maybe he doesn't have back pain all the time, maybe he doing things against the MD's advice etc...will all be things that would be part of the information that the investigation elicits and will be used to make their determination as to whether or not he is being fraudulent.

Do you know anyone who has applied for SSI? Do you know the extent of documentation and physical assessment they go through? And that SSI has their own doctors examine the claimant? Most people need to hire an attorney and live for months without an income before they are awarded benefits.

Frankly, in this day and age, if this guy was granted SSI, he went through a lot already to prove he needed it. An allegation of fraud can cause him to go through it all again. I would rather have faith that the system catches cheaters than make that call myself and bring the authorities into it, especially in the case of a relative.

It sounds like the OP isn't doing it 'lightly'...as a matter of fact she has not done it at all yet...otherwise she would have come on here, guns blazing and posted about how she already turned in someone for insurance/etc. fraud.

agnesQ

I took the OP differently than you did. What it sounded like to me is that she's already played judge and jury and is just looking for a phone number to call or a website where she can rat the guy out. It sounds pretty cold-hearted on her part. And we don't know who else "Bill" is related to in her family. If she does this, she is interfering with all their livelihoods.

 

[agnes!]

It sounds like the OP isn't doing it 'lightly'...as a matter of fact she has not done it at all yet...otherwise she would have come on here, guns blazing and posted about how she already turned in someone for insurance/etc. fraud.

agnes!

... I took the OP differently than you did. What it sounded like to me is that she's already played judge and jury and is just looking for a phone number to call or a website where she can rat the guy out. It sounds pretty cold-hearted on her part. And we don't know who else "Bill" is related to in her family. If she does this, she is interfering with all their livelihoods.

Yes, you did...you and I will just have to agree to disagree on that subject .

agnes!

 

[JerseyJanice]

Yes, you did...you and I will just have to agree to disagree on that subject .

agnes!

Yes, I did what? I don't understand what you mean by that.

What I'm saying is that I wouldn't turn a relative into the authorities, largely because I have relatives with heavy duty disabilities who collect(ed) SSI benefits, and I am aware of the hoops they had to jump through to get the benefits awarded. I find it hard to believe that in this day and age, this man was able to fool both an insurance company and the Social Security Administration. And in any event, I'd guess that they have more information about the case than the OP does as an extended relative.

Really, nothing in your post makes sense to me. You don't know what, if anything, she would have posted if she reported the guy already. "Guns blazing..." is strictly conjecture on your part.

 

[agnes!]

Yes, you did...you and I will just have to agree to disagree on that subject .

agnes!

Yes, I did what? I don't understand what you mean by that.

What I meant was that you took the OP differently than I did and also that you & I continue to take her differently than each other.

What I'm saying is that I wouldn't turn a relative into the authorities, largely because I have relatives with heavy duty disabilities who collect(ed) SSI benefits, and I am aware of the hoops they had to jump through to get the benefits awarded. I find it hard to believe that in this day and age, this man was able to fool both an insurance company and the Social Security Administration. And in any event, I'd guess that they have more information about the case than the OP does as an extended relative.

Really, nothing in your post makes sense to me. You don't know what, if anything, she would have posted if she reported the guy already. "Guns blazing..." is strictly conjecture on your part.

Ah, conjecture on both our parts yes? You're conjecturing that she is going to turn this relative of her DH's in. If she had already made up her mind, the OP would have perhaps come on the DIS and posted "I turned in a relative for insurance & SSDI fraud" or "I am going to turn in a relative for insurance & SSDI fraud". I am conjecturing that she has not quite made up her mind, based on her OP, which is below. (Also, the OP never said how close the relationship is between her DH & this person, they could be brothers, they could be cousins twice-removed, we don't know.)

We know a man "Bill" who we are absolutely sure is committing fraud and want someone to at least look into it. He is a relative of my dh's and he agrees it's time someone looks closer at "Bill".

"Bill" was in a car accident about 3 yrs ago. This was a pretty minor accident and "Bill" was able to drive his car home from the scene and not go to the hospital until the next day for back pain.

Fast forward 3 yrs and "Bill" is no longer working and was awarded permanent disability recently through social security and he still has a lawsuit against the insurance company. I never thought in a million years he'd win the first one, because he is NOT disabled.

"Bill" claims his back is so bad he can longer function, lift anything, stand for more than a few minutes, or walk for more than a 100 feet at a time. However since the accident "Bill" plays horseshoes, walks for hours at a time, has completely remodeled an entire house including hanging drywall on the ceiling (lifting it up there and hanging it), he has worked extensively on his car. He wears a back brace and walks w/ a cane only when he's where he thinks people will see him. A few months ago we were on a camping trip w/ him and he used none of these things and helped carry wood and stuff.

Anyhow, for the car insurance company I found a phone # to call and report possible fraud, but I cannot find anything for SSDI. Does this sound like the type of thing that would be reported? Should we stay out of it?

Sorry that I'm not making sense to you.

agnes!

 

[JerseyJanice]

You're clearer to me now, Agnes. For a minute there, I thought you had my posts mixed up with someone else.

I guess the title of this thread is what had me thinking that the OP had already decided she is going to report the man. It does ask, "How to report fraud?"

To answer the OP's final question, "should we stay out of it?" my answer is yes, I think the OP should mind her own business and leave it up to the professionals at the insurance company and SSA to decide whether this person should be receiving benefits. They have full access to all his medical information, including his psychological tests, and are in a much better position to make a determination of his medical status.

I also think that if she is close enough to go on a camping trip with the guy, she and her DH won't feel good in the long run for meddling in the man's affairs.

 

[kaytieeldr]

Respectfully, I will say again that, based on what I know of the OP from the DIS, she doesn't make decisions lightly.

Yes, it's true, the relative may not be scamming the insurance company and SSI. But if he is, isn't it better for that to be discovered now, before much has been paid to him (in the strong likelihood that he doesn't pay it back)? Less fraudulent funds being distributed by the insurance company OR Social Security, less burden on the taxpayers?

 

[Disney Doll]

Do you know anyone who has applied for SSI? Do you know the extent of documentation and physical assessment they go through? And that SSI has their own doctors examine the claimant? Most people need to hire an attorney and live for months without an income before they are awarded benefits.

Frankly, in this day and age, if this guy was granted SSI, he went through a lot already to prove he needed it. An allegation of fraud can cause him to go through it all again. I would rather have faith that the system catches cheaters than make that call myself and bring the authorities into it, especially in the case of a relative.



I took the OP differently than you did. What it sounded like to me is that she's already played judge and jury and is just looking for a phone number to call or a website where she can rat the guy out. It sounds pretty cold-hearted on her part. And we don't know who else "Bill" is related to in her family. If she does this, she is interfering with all their livelihoods.

Actually, I know 2 people in SSI. My brother-in-law who has a really bad heart (barely staying off the transplant list) and my sister-in-law who could or could not be faking it...I don't live close enough to be able to determine for absolutely sure.

Brother-in-law...took him quite a long time to get it and required mountains of documentation. His heart is so bad he is truly in need of it.

Sister-in-law...got it fairly quickly based on a claim of dizziness after taking an antibiotic which she claimed ruined her equilibrium so she couldn't stand without being dizzy, couldn't drive etc. Except for she sent us video of her family's vacation in Cocoa Beach FL where she is holding her 4 year old son and holding him by his arms and spinning in complete circles in the water before flinging him in. That kind of makes the whole dizzy thing hard for ME to believe...and I am quite sure they were in Cocoa Beach and not Lourdes in France, so I know I didn't witness a miracle. Also the fact that she works and gets paid under the table makes the whole "I can't work" thing hard for me to believe, but heck, since you said they have to jump through hoops to get it, I am sure that every single person in every single SSI office in the country does their job to the absolute best of their ability...that's why Social Security is in such good shape right now.

As far as the OP ruining the family's livelihood...the man who is possibly taking SSI money under false pretenses is ruining his family's livelihood, not the OP.

 

[JerseyJanice]

Respectfully, I will say again that, based on what I know of the OP from the DIS, she doesn't make decisions lightly.

Yes, it's true, the relative may not be scamming the insurance company and SSI. But if he is, isn't it better for that to be discovered now, before much has been paid to him (in the strong likelihood that he doesn't pay it back)? Less fraudulent funds being distributed by the insurance company OR Social Security, less burden on the taxpayers?

IMO, it's pretty hard-hearted to be more concerned about the insurance company, SS and/or the burden on taxpayers than about your relatives.

I don't know the OP well so I can't comment on how lightly or not she makes decisions. What I can comment on is personal experiences with SS, and I'm amazed that anyone could get a determination less than three years after an accident. SS is notorious for dragging cases out for years. The fact that this guy got it so quickly shows there is convincing evidence that he was severely disabled.

Honestly, I had one relative with a brain tumor, another with an advanced Parkinson's disease, and yet another with leukemia who didn't get their SS benefits that quickly or easily. I find it hard to imagine that a person with a feigned back injury would.

 

[PixieTopaz]

Respectfully, I will say again that, based on what I know of the OP from the DIS, she doesn't make decisions lightly.

?

Can you really know a person simply from their posts on a message board?

 

[kaytieeldr]

I don't know the OP well so I can't comment on how lightly or not she makes decisions. What I can comment on is personal experiences with SS, and I'm amazed that anyone could get a determination less than three years after an accident. SS is notorious for dragging cases out for years. The fact that this guy got it so quickly shows there is convincing evidence that he was severely disabled.

Respectfully, it could also be convincing evidence how good he is at faking a 'permanent disability'. Based on the things the OP has indicated the relative has been able to do - apparently without assistance from any person or supportive device - it would appear this could be a case of fraud. That's not for any of us to decide. It's for investigators - first to determine if the situation warrants further study, and then if they do, to follow up. One person saying, "I think X is committing fraud (or cheating, or lying, or whatever" doesn't even mean the agency/company will agree it's worth checking.

 

[kaytieeldr]

Can you really know a person simply from their posts on a message board?

We can get into an entirely separate philosophical discussion relating to 'does anybody ever really know anybody?", but that's a topic for a different thread. For the third time in this thread, I will say, based on what I know of the OP from her posts on the DIS, she doesn't jump to conclusions, make snap judgments, or make decisions lightly.

Do I know her? Nope. Would I recognize her in a crowd? Nope. Would I recognize her if we were the only two people in a room? Only if I knew she were going to be there at the same time as me. Do I know her thoughts, her feelings, her ideas? No. I never claimed to know much about her. I make my statements based on what I know from her posts here.

I hope that's clear.