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42 U.S.C. § 1383c — Penalties for fraud
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** 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 under this subchapter,
(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,
(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, or
(5) conspires to commit any offense described in any of paragraphs (1) through (3),
shall be fined under title 18, imprisoned not more than 5 years, or both, except that in the case of a person who receives a fee or other income for services performed in connection with any determination with respect to benefits under this subchapter (including a claimant representative, translator, or current or former employee of the Social Security Administration), or who is a physician or other health care provider who submits, or causes the submission of, medical or other evidence in connection with any such determination, such person shall be guilty of a felony and upon conviction thereof shall be fined under title 18, or impr
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Source file: Laws/federal/codes/united-states-code/title-42/section-1383c-penalties-for-fraud--847e49e06b.md
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Source location: Title 42, Chapter 7, § 1383c; chapter-007-social-security.md
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**(a) In general** 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 under this subchapter,
(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,
(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, or
(5) conspires to commit any offense described in any of paragraphs (1) through (3),
shall be fined under title 18, imprisoned not more than 5 years, or both, except that in the case of a person who receives a fee or other income for services performed in connection with any determination with respect to benefits under this subchapter (including a claimant representative, translator, or current or former employee of the Social Security Administration), or who is a physician or other health care provider who submits, or causes the submission of, medical or other evidence in connection with any such determination, such person shall be guilty of a felony and upon conviction thereof shall be fined under title 18, or imprisoned for not more than ten years, or both.
**(b) Restitution**
(1) Any Federal court, when sentencing a defendant convicted of an offense under subsection (a), may order, in addition to or in lieu of any other penalty authorized by law, that the defendant make restitution to the Commissioner of Social Security, in any case in which such offense results in—
(A) the Commissioner of Social Security making a benefit payment that should not have been made, or
(B) an individual suffering a financial loss due to the defendant’s violation of subsection (a) in his or her capacity as the individual’s representative payee appointed pursuant to [section 1383(a)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1383/a/2&num=0&edition=prelim).
(2) Sections 3612, 3663, and 3664 of title 18 shall apply with respect to the issuance and enforcement of orders of restitution under this subsection. In so applying such sections, the Commissioner of Social Security shall be considered the victim.
(3) If the court does not order restitution, or orders only partial restitution, under this subsection, the court shall state on the record the reasons therefor.
(4)
(A) Except as provided in subparagraph (B), funds paid to the Commissioner of Social Security as restitution pursuant to a court order shall be deposited as miscellaneous receipts in the general fund of the Treasury.
(B) In the case of funds paid to the Commissioner of Social Security pursuant to paragraph (1)(B), the Commissioner of Social Security shall certify for payment to the individual described in such paragraph an amount equal to the lesser of the amount of the funds so paid or the individual’s outstanding financial loss as described in such paragraph, except that such amount may be reduced by any overpayment of benefits owed under this subchapter, subchapter II, or subchapter VIII by the individual.
**(c) Prohibition on certification as representative payee** Any person or entity convicted of a violation of subsection (a) of this section or of [section 408 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section408&num=0&edition=prelim) may not be certified as a representative payee under [section 1383(a)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1383/a/2&num=0&edition=prelim).
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Federal law — U.S. Code and appendices · legal_authorities
The Covenant to Establish a Commonwealth of the Northern Mariana Islands in Political Union with the United States of America, the text of which is as follows, is hereby approved.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Rules and regulations; procedures** The Commissioner of Social Security shall have full power and authority to make rules and regulations and to establish procedures, not inconsistent with the provisions of this subchapter, which are necessary or appropriate to carry out such provisions, and shall adopt reasonable and proper rules and regulations to regulate and provide for the nature and extent of the proofs and evidence and the method of taking and furnishing the same in order to establish the right to benefits hereunder.
**(b) Administrative determination of entitlement to benefits; findings of fact; hearings; investigations; evidentiary hearings in reconsiderations of disability benefit terminations; subsequent applications**
(1) The Commissioner of Social Security is directed to make findings of fact, and decisions as to the rights of any individual applying for a payment under this subchapter. Any such decision by the Commissioner of Social Security which involves a determination of disability and which is in whole or in part unfavorable to such individual shall contain a statement of the case, in understandable language, setting forth a discussion of the evidence, and stating the Commissioner’s determination and the reason or reasons upon which it is based. Upon request by any such individual or upon request by a wife, divorced wife, widow, surviving divorced wife, surviving divorced mother, surviving divorced father, husband, divorced husband, widower, surviving divorced husband, child, or parent who makes a showing in writing that his or her rights may be prejudiced by any decision the Commissioner of Social Security has rendered, the Commissioner shall give such applicant and such other individual reasonable notice and opportunity for a hearing with re
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 405
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** Whoever—
(1) for the purpose of causing an increase in any payment authorized to be made under this subchapter, or for the purpose of causing any payment to be made where no payment is authorized under this subchapter, shall make or cause to be made any false statement or representation (including any false statement or representation in connection with any matter arising under subchapter E of chapter 1, or subchapter A or E of chapter 9 of the Internal Revenue Code of 1939, or chapter 2 or 21 or subtitle F of the Internal Revenue Code of 1954) as to—
(A) whether wages were paid or received for employment (as said terms are defined in this subchapter and the Internal Revenue Code), or the amount of wages or the period during which paid or the person to whom paid; or
(B) whether net earnings from self-employment (as such term is defined in this subchapter and in the Internal Revenue Code) were derived, or as to the amount of such net earnings or the period during which or the person by whom derived; or
(C) whether a person entitled to benefits under this subchapter had earnings in or for a particular period (as determined under [section 403(f) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section403/f&num=0&edition=prelim) for purposes of deductions from benefits), or as to the amount thereof; or
(2) makes or causes to be made any false statement or representation of a material fact in any application for any payment or for a disability determination under this subchapter; or
(3) at any time makes or causes to be made any false statement or representation of a material fact for use in determining rights to payment under this subchapter; or
(4) having knowledge of the occurrence of any event affecting (
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 408
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Federal law — U.S. Code and appendices · legal_authorities
For the purpose of enabling each State, as far as practicable under the conditions in such State, to furnish financial assistance to aged needy individuals, there is hereby authorized to be appropriated for each fiscal year a sum sufficient to carry out the purposes of this subchapter. The sums made available under this section shall be used for making payments to States which have submitted, and had approved by the Secretary of Health and Human Services (hereinafter referred to as the “Secretary”), State plans for old-age assistance.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 301
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Federal law — U.S. Code and appendices · legal_authorities
**(a) “Eligible individual” defined**
(1) Each aged, blind, or disabled individual who does not have an eligible spouse and—
(A) whose income, other than income excluded pursuant to [section 1382a(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382a/b&num=0&edition=prelim), is at a rate of not more than $1,752 (or, if greater, the amount determined under [section 1382f of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382f&num=0&edition=prelim)) for the calendar year 1974 or any calendar year thereafter, and
(B) whose resources, other than resources excluded pursuant to [section 1382b(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382b/a&num=0&edition=prelim), are not more than (i) in case such individual has a spouse with whom he is living, the applicable amount determined under paragraph (3)(A), or (ii) in case such individual has no spouse with whom he is living, the applicable amount determined under paragraph (3)(B),
(2) Each aged, blind, or disabled individual who has an eligible spouse and—
(A) whose income (together with the income of such spouse), other than income excluded pursuant to [section 1382a(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382a/b&num=0&edition=prelim), is at a rate of not more than $2,628 (or, if greater, the amount determined under [section 1382f of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382f&num=0&edition=prelim)) for the calendar year 1974, or any calendar year thereafter, and
(B) whose resources (together with the resources of such spouse), other than resources excluded pursuant to [sectio
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1382b
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Computation of amount** From the sums appropriated therefor, the Secretary (except as otherwise provided in this section) shall pay to each State which has a plan approved under this subchapter, for each quarter, beginning with the quarter commencing January 1, 1966—
(1) an amount equal to the Federal medical assistance percentage (as defined in [section 1396d(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396d/b&num=0&edition=prelim), subject to subsections (g) and (j) of this section and [section 1396r–4(f) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r–4/f&num=0&edition=prelim)) of the total amount expended during such quarter as medical assistance under the State plan; plus
(2)
(A) an amount equal to 75 per centum of so much of the sums expended during such quarter (as found necessary by the Secretary for the proper and efficient administration of the State plan) as are attributable to compensation or training of skilled professional medical personnel, and staff directly supporting such personnel, of the State agency or any other public agency; plus
(B) notwithstanding paragraph (1) or subparagraph (A), with respect to amounts expended for nursing aide training and competency evaluation programs, and competency evaluation programs, described in [section 1396r(e)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396r/e/1&num=0&edition=prelim) (including the costs for nurse aides to complete such competency evaluation programs), regardless of whether the programs are provided in or outside nursing facilities or of the skill of the personnel involved in such programs, an amount equal to 50 percent (or, for calendar
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396b
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Authority or requirements to cover additional individuals** For provisions of law which make additional individuals eligible for medical assistance under this subchapter, see the following:
(1) **AFDC**
(A) Section 602(a)(32) 11 See References in Text note below. of this title (relating to individuals who are deemed recipients of aid but for whom a payment is not made).
(B) Section 602(a)(37) 1 of this title (relating to individuals who lose AFDC eligibility due to increased earnings).
(C) Section 606(h) 1 of this title (relating to individuals who lose AFDC eligibility due to increased collection of child or spousal support).
(D) Section 682(e)(6) 1 of this title (relating to certain individuals participating in work supplementation programs).
(2) **SSI**
(A) [Section 1382(e) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382/e&num=0&edition=prelim) (relating to treatment of couples sharing an accommodation in a facility).
(B) [Section 1382h of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1382h&num=0&edition=prelim) (relating to benefits for individuals who perform substantial gainful activity despite severe medical impairment).
(C) [Section 1383c(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1383c/b&num=0&edition=prelim) (relating to preservation of benefit status for disabled widows and widowers who lost SSI benefits because of 1983 changes in actuarial reduction formula).
(D) [Section 1383c(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1383c/c&num=0&edition=prelim) (relating to individuals who lose eligibility for SSI benefits due to entitlement to child
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 1396v
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Old-age insurance benefits** Every individual who—
(1) is a fully insured individual (as defined in [section 414(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section414/a&num=0&edition=prelim)),
(2) has attained age 62, and
(3) has filed application for old-age insurance benefits or was entitled to disability insurance benefits for the month preceding the month in which he attained retirement age (as defined in section 416(l) of this title),
shall be entitled to an old-age insurance benefit for each month, beginning with—
(A) in the case of an individual who has attained retirement age (as defined in section 416(l) of this title), the first month in which such individual meets the criteria specified in paragraphs (1), (2), and (3), or
(B) in the case of an individual who has attained age 62, but has not attained retirement age (as defined in section 416(l) of this title), the first month throughout which such individual meets the criteria specified in paragraphs (1) and (2) (if in that month he meets the criterion specified in paragraph (3)),
and ending with the month preceding the month in which he dies. Except as provided in subsection (q) and subsection (w), such individual’s old-age insurance benefit for any month shall be equal to his primary insurance amount (as defined in [section 415(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section415/a&num=0&edition=prelim)) for such month.
**(b) Wife’s insurance benefits**
(1) The wife (as defined in [section 416(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section416/b&num=0&edition=prelim)) and every divorced wife (as defined in [section 416(d) of this title](https://uscode.house.gov/
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 402
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Federal law — U.S. Code and appendices · legal_authorities
Page 2886
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 1383c
§ 1383c. Eligibility for medical assistance of aged,
blind, or disabled individuals under State’s
medical assistance plan
(a) Determination by Commissioner pursuant to
agreement between Commissioner and State;
costs
The Commissioner of Social Security may
enter into an agreement with any State which
wishes to do so under which the Commissioner
will determine eligibility for medical assistance
in the case of aged, blind, or disabled individuals
under such State’s plan approved under sub-
chapter XIX. Any such agreement shall provide
for payments by the State, for use by the Com-
missioner of Social Security in carrying out the
agreement, of an amount equal to one-half of
the cost of carrying out the agreement, but in
computing such cost with respect to individuals
eligible for benefits under this subchapter, the
Commissioner of Social Security shall include
only those costs which are additional to the
costs incurred in carrying out this subchapter.
(b) Preservation of benefit status for certain dis-
abled widows and widowers
(1) An eligible disabled widow or widower (de-
scribed in paragraph (2)) who is entitled to a
widow’s or widower’s insurance benefit based on
a disability for any month under section 402(e)
or (f) of this title but is not eligible for benefits
under this subchapter in that month, and who
applies for the protection of this subsection
under paragraph (3), shall be deemed for pur-
poses of subchapter XIX to be an individual with
respect to whom benefits under this subchapter
are paid in that month if he or she—
(A) has been continuously entitled to such
widow’s or widower’s insurance benefits from
the first month for which the increase de-
scribed in paragraph (2)(C
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 1383c
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