§1320a–8a — Title 42 The Public Health and Welfare | U.S. Code

Summary

Anyone who lies, carelessly ignores the truth, or leaves out or hides important facts when giving information to get or keep monthly insurance benefits (subchapter II) or payments under subchapter XVI can lose those benefits. The penalty is no payments under subchapter II and ineligibility for cash payments under subchapter XVI. The time without benefits rises each time a person is found to have done this: 6 months for the first time, 12 months for the second, and 24 months for the third or later times. While stopped from getting payments, the person is still treated as if they were eligible and receiving benefits for deciding eligibility under subchapters XVIII and XIX and for figuring benefits for other people. The term “benefits” also covers certain State supplementary payments. The Social Security Commissioner must talk with the Inspector General before starting these actions.

Title 42, §1320a–8a

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(a)Any person who—

(1)makes, or causes 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 monthly insurance benefits under subchapter II or benefits or payments under subchapter XVI that the person knows or should know is false or misleading,

(2)makes such a statement or representation for such use with knowing disregard for the truth, or

(3)omits from a statement or representation for such use, or otherwise withholds disclosure of, a fact which the person knows or should know is material to the determination of any initial or continuing right to or the amount of monthly insurance benefits under subchapter II or benefits or payments under subchapter XVI, if the person knows, or should know, that the statement or representation with such omission is false or misleading or that the withholding of such disclosure is misleading,

(b)The penalty described in this subsection is—

(1)nonpayment of benefits under subchapter II that would otherwise be payable to the person; and

(2)ineligibility for cash benefits under subchapter XVI,

(c)The duration of the applicable period, with respect to a determination by the Commissioner under subsection (a) that a person has engaged in conduct described in subsection (a), shall be—

(1)six consecutive months, in the case of the first such determination with respect to the person;

(2)twelve consecutive months, in the case of the second such determination with respect to the person; and

(3)twenty-four consecutive months, in the case of the third or subsequent such determination with respect to the person.

(d)A person subject to a period of nonpayment of benefits under subchapter II or ineligibility for subchapter XVI benefits by reason of this section nevertheless shall be considered to be eligible for and receiving such benefits, to the extent that the person would be receiving or eligible for such benefits but for the imposition of the penalty, for purposes of—

(1)determination of the eligibility of the person for benefits under subchapters XVIII and XIX; and

(2)determination of the eligibility or amount of benefits payable under subchapter II or XVI to another person.

(e)In this section, the term “benefits under subchapter VIII or XVI” includes State supplementary payments made by the Commissioner pursuant to an agreement under section 1010a or 1382e(a) of this title or section 212(b) of Public Law 93–66, as the case may be.

(f)The Commissioner of Social Security shall consult with the Inspector General of the Social Security Administration regarding initiating actions under this section.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 212(b) of Public Law 93–66, referred to in subsec. (e), is section 212(b) of Pub. L. 93–66, title II, July 9, 1973, 87 Stat. 155, which is set out as a note under section 1382 of this title.

Amendments

2004—Subsec. (a). Pub. L. 108–203 substantially rewrote text of subsec. (a). Prior to amendment, text read as follows: “Any person who makes, or causes 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— “(1) monthly insurance benefits under subchapter II of this chapter; or “(2) benefits or payments under subchapter XVI of this chapter, that the person knows or should know is false or misleading or knows or should know omits a material fact or who makes such a statement with knowing disregard for the truth shall be subject to, in addition to any other penalties that may be prescribed by law, a penalty described in subsection (b) to be imposed by the Commissioner of Social Security.” 2000—Subsec. (e). Pub. L. 106–554, § 1(a)(1) [title V, § 518(b)(2)(B), (D)], inserted “1010a or” after “agreement under section” and “, as the case may be” before period at end. Pub. L. 106–554, § 1(a)(1) [title V, § 518(b)(2)(C)], which directed the amendment of subsec. (e) by inserting “1010A or” before “1382(e)(a)”, could not be executed because “1382(e)(a)” does not appear in text. Pub. L. 106–554, § 1(a)(1) [title V, § 518(b)(2)(A)], which directed the amendment of subsec. (e) by inserting “VIII or” after “benefits under”, was executed by making the insertion after “benefits under subchapter” to reflect the probable intent of Congress.

Statutory Notes and Related Subsidiaries

Effective Date

of 2004 AmendmentAmendment by Pub. L. 108–203 applicable with respect to violations committed after Nov. 27, 2006, see section 201(d) of Pub. L. 108–203, set out as a note under section 1320a–8 of this title.

Effective Date

Section applicable to statements and representations made on or after Dec. 14, 1999, see section 207(e) of Pub. L. 106–169, set out as an

Effective Date

of 1999 Amendment note under section 402 of this title.

Regulations

Pub. L. 106–169, title II, § 207(d), Dec. 14, 1999, 113 Stat. 1838, required, within 6 months after Dec. 14, 1999, the development of

Regulations

prescribing the administrative process for making determinations under this section and guidance on discretion in imposing penalties.

§1320a–8a Administrative procedure for imposing penalties for false or misleading statements

Summary

Title 42, §1320a–8a

Notes & Related Subsidiaries

Editorial Notes

References in Text

Amendments

Statutory Notes and Related Subsidiaries

Effective Date

Effective Date

Effective Date

Regulations

Regulations

Citations & Metadata