42 U.S.C. § 1011 — Penalties for fraud

Page 2510 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1010a (d) Suspension and termination of benefits Regulations prescribed by the Commissioner of Social Security under subsection (a) may pro- vide for the suspension and termination of enti- tlement to benefits under this subchapter as the Commissioner determines is appropriate. (Aug. 14, 1935, ch. 531, title VIII, § 810, as added Pub. L. 106–169, title II, § 251(a), Dec. 14, 1999, 113 Stat. 1852.) Editorial Notes PRIOR PROVISIONS For prior provisions, see note set out under section 1001 of this title. § 1010a. Optional Federal administration of State recognition payments (a) In general The Commissioner of Social Security may enter into an agreement with any State (or po- litical subdivision thereof) that provides cash payments on a regular basis to individuals enti- tled to benefits under this subchapter under which the Commissioner of Social Security shall make such payments on behalf of such State (or subdivision). (b) Agreement terms (1) In general Such agreement shall include such terms as the Commissioner of Social Security finds necessary to achieve efficient and effective ad- ministration of both this subchapter and the State program. (2) Financial terms Such agreement shall provide for the State to pay the Commissioner of Social Security, at such times and in such installments as the parties may specify— (A) an amount equal to the expenditures made by the Commissioner of Social Secu- rity pursuant to such agreement as pay- ments to individuals on behalf of such State; and (B) an administration fee to reimburse the administrative expenses incurred by the Commissioner of Social Security in making payments to individuals on behalf of the State. (c) Special disposition of administration fees Administration fees, upon collection, shall be credited to a special fund established in the Treasury of the United States for State recogni- tion payments for certain World War II vet- erans. The amounts so credited, to the extent and in the amounts provided in advance in ap- propriations Acts, shall be available to defray expenses incurred in carrying out this sub- chapter. (Aug. 14, 1935, ch. 531, title VIII, § 810A, as added Pub. L. 106–554, § 1(a)(1) [title V, § 518(a)], Dec. 21, 2000, 114 Stat. 2763, 2763A–73.) § 1011. Penalties for fraud (a) In general Whoever— (1) knowingly and willfully makes or causes to be made any false statement or representa- tion of a material fact in an application for benefits under this subchapter; (2) at any time knowingly and willfully makes or causes to be made any false state- ment or representation of a material fact for use in determining any right to the benefits; (3) having knowledge of the occurrence of any event affecting— (A) his or her initial or continued right to the benefits; or (B) the initial or continued right to the benefits of any other individual in whose be- half he or she has applied for or is receiving the benefit, conceals or fails to disclose the event with an intent fraudulently to secure the benefit ei- ther 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 will- fully converts the benefit or any part thereof to a use other than for the use and benefit of the other individual; or (5) conspires to commit any offense de- scribed 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 in- come for services performed in connection with any determination with respect to benefits under this subchapter (including a claimant rep- resentative, translator, or current or former em- ployee of the Social Security Administration), or who is a physician or other health care pro- vider 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) Court order for restitution (1) In general Any Federal court, when sentencing a de- fendant convicted of an offense under sub- section (a), may order, in addition to or in lieu of any other penalty authorized by law, that the defendant make restitution to the Com- missioner 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 sub- section (a) in his or her capacity as the indi- vidual’s representative payee appointed pur- suant to section 1007(i) of this title. (2) Related provisions Sections 3612, 3663, and 3664 of title 18 shall apply with respect to the issuance and en- forcement of orders of restitution under this subsection. In so applying such sections, the Commissioner of Social Security shall be con- sidered the victim. (3) Stated reasons for not ordering restitution If the court does not order restitution, or or- ders only partial restitution, under this sub- Page 2511 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1012 section, the court shall state on the record the reasons therefor. (4) Receipt of restitution payments (A) In general Except as provided in subparagraph (B), funds paid to the Commissioner of Social Se- curity as restitution pursuant to a court order shall be deposited as miscellaneous re- ceipts in the general fund of the Treasury. (B) Payment to the individual In the case of funds paid to the Commis- sioner of Social Security pursuant to para- graph (1)(B), the Commissioner of Social Se- curity shall certify for payment to the indi- vidual described in such paragraph an amount equal to the lesser of the amount of the funds so paid or the individual’s out- standing 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 XVI by the individual. (Aug. 14, 1935, ch. 531, title VIII, § 811, as added Pub. L. 106–169, title II, § 251(a), Dec. 14, 1999, 113 Stat. 1852; amended Pub. L. 108–203, title II, § 209(b), Mar. 2, 2004, 118 Stat. 514; Pub. L. 114–74, title VIII, § 813(a)(2), (b)(2), Nov. 2, 2015, 129 Stat. 602, 603.) Editorial Notes PRIOR PROVISIONS For prior provisions, see note set out under section 1001 of this title. AMENDMENTS 2015—Subsec. (a). Pub. L. 114–74, § 813(b)(2), inserted before period at end of concluding provisions ‘‘, 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 sub- chapter (including a claimant representative, trans- lator, or current or former employee of the Social Se- curity Administration), or who is a physician or other health care provider who submits, or causes the sub- mission 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’’. Subsec. (a)(5). Pub. L. 114–74, § 813(a)(2), added par. (5). 2004—Subsec. (b). Pub. L. 108–203 amended heading and text of subsec. (b) generally. Prior to amendment, text read as follows: ‘‘If a person or organization vio- lates subsection (a) of this section in the person’s or or- ganization’s role as, or in applying to become, a rep- resentative payee under section 1007 of this title on be- half of a qualified individual, and the violation includes a willful misuse of funds by the person or entity, the court may also require that full or partial restitution of funds be made to the qualified individual.’’ Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2004 AMENDMENT Amendment by Pub. L. 108–203 applicable with re- spect to violations occurring on or after Mar. 2, 2004, see section 209(d) of Pub. L. 108–203, set out as a note under section 408 of this title. § 1012. Definitions In this subchapter: (1) World War II veteran The term ‘‘World War II veteran’’ means a person who— (A) served during World War II— (i) in the active military, naval, or air service of the United States during World War II; or (ii) in the organized military forces of the Government of the Commonwealth of the Philippines, while the forces were in the service of the Armed Forces of the United States pursuant to the military order of the President dated July 26, 1941, including among the military forces orga- nized guerrilla forces under commanders appointed, designated, or subsequently recognized by the Commander in Chief, Southwest Pacific Area, or other com- petent authority in the Army of the United States, in any case in which the service was rendered before December 31, 1946; and (B) was discharged or released therefrom under conditions other than dishonorable— (i) after service of 90 days or more; or (ii) because of a disability or injury in- curred or aggravated in the line of active duty. (2) World War II The term ‘‘World War II’’ means the period beginning on September 16, 1940, and ending on July 24, 1947. (3) Supplemental security income benefit under subchapter XVI The term ‘‘supplemental security income benefit under subchapter XVI’’, except as oth- erwise provided, includes State supplementary payments which are paid by the Commissioner of Social Security pursuant to an agreement under section 1382e(a) of this title or section 212(b) of Public Law 93–66. (4) Federal benefit rate under subchapter XVI The term ‘‘Federal benefit rate under sub- chapter XVI’’ means, with respect to any month, the amount of the supplemental secu- rity income cash benefit (not including any State supplementary payment which is paid by the Commissioner of Social Security pursu- ant to an agreement under section 1382e(a) of this title or section 212(b) of Public Law 93–66) payable under subchapter XVI for the month to an eligible individual with no income. (5) United States The term ‘‘United States’’ means, notwith- standing section 1301(a)(1) of this title, only the 50 States, the District of Columbia, and the Commonwealth of the Northern Mariana Islands. (6) Benefit income The term ‘‘benefit income’’ means any re- curring payment received by a qualified indi- vidual as an annuity, pension, retirement, or disability benefit (including any veterans’ compensation or pension, workmen’s com- pensation payment, old-age, survivors, or dis- ability insurance benefit, railroad retirement annuity or pension, and unemployment insur-