Fraud and VA
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Fraud against the Federal Government (VA) is no joke.

Fraud is denied as:

“An act committed when a person knowingly makes or causes to be made or conspires, combines, aids, or assists in, agrees to, arranges for, or in any way procures the making or presentation of a false or fraudulent affidavit, declaration, certificate, statement, voucher, or paper, concerning any claim for benefits under any of the laws administered by the Department of Veterans Affairs (except laws relating to insurance benefits).” (38 CFR 3.901)

Those accused of fraud are given the same due process as any other proposed negative action.

  • For details on due process click HERE.

Penalties of Fraud

VA Office of Inspector General (OIG) is in charge of determining and pursuing criminal/civil charges for fraud. Even if they decline to push for criminal or civil charges, penalties such as loss of benefits can still happen.

Penalties for fraud include:

  • Up to 20 years of imprisonment;

  • Up to loss of ALL VA benefits from date of fraud (besides insurance);

    • Known as forfeiture of gratuitousness benefits (ALL but insurance) this punishment is not always pushed;

  • Civil penalties (fines);

  • Debt for over-payments; and

  • Inability to claim additional benefits (based on service BEFORE the forfeiture).

IMPORTANT NOTES:

  • All regulatory protections of evaluation/service-connection do NOT apply in cases of fraud.

  • Dependents using Chapter 35 education benefits who did NOT participate in the fraud ARE allowed to continue to use their benefit up to:

    • End of the term;

    • Till their benefit expires; or

    • 12 weeks from the loss of benefits due to fraud being determined - WHICHEVER happens first.

  • Debt for over-payment will NOT be created for the dependent who did NOT participate in the fraud.

    • If the dependent DID participate in the fraud then benefits are ended immediately and retroactively revoked; resulting in a debt.

NOTES:

  • In the case of forfeiture, if the Veteran was somehow allowed to return to service or they become eligible for benefits via 1151, new entitlements based on the new period of service/1151 ARE allowed.

  • Apportionment (payments made to a dependent instead of the Veteran) are NOT allowed in the case of forfeiture.

  • Survivor benefits CAN be paid to dependents if eligible - if not involved in the fraud.

  • Debts created by fraud CANNOT be waived!

Examples of Fraud

  • Failing to or under reporting income or net-worth to qualify for benefits such as: VA Pension, Total Disability Individual Unemployability (TDIU), or Heath care

  • Failure of a Fiduciary to notify VA of the death of a beneficiary and to continue to draw benefits of the deceased

  • Lying to an examiner about the history of, or severity of a condition

  • Withholding information (omitting information) on an application or when specifically asked by an agent of the VA

  • Falsifying/forging records

  • Saying you are attending education courses when you are not

  • VA receives a document electronically ‘signed’ by the Veteran, after their passing

  • Claiming Dependents who are not yours/do not exist or lying about your relationship to them

Examples That Are NOT Fraud

Not everything questionable or dubious is considered fraud:

  • VA made a Clear and Unmistakable Error (CUE) (due to no ill-dealings of the Veteran) and over evaluated, provided an earlier Effective date, or granted Service-connection in error

    • If these errors found in the future, the VA CAN correct these errors unless the condition was rated for at least 20 and 10 years; respectively.

  • Submitting a claim for benefits when NOT entitled to the benefit

  • NOT providing information that might/would be harmful to a claim when the information is NOT requested. You do NOT have to VOLUNTEER information that was NOT requested by a VA agent or form/application. HOWEVER, you DO have to provide this information to the best of your ability knowledge when specifically asked! Failure to provide information upon request (leaving a question blank when a truthful answer might be harmful, could be fraudulent).

  • NOT reporting improvement of a condition.

    • UNLESS ALL of the following are true:

      • Person has knowledge of the facts on which eligibility for or entitlement to the benefits is based.

      • Person had knowledge of a change in circumstances and KNEW that such change could affect entitlement or eligibility.

      • Person chose not to notify VA of the change in circumstances with the actual intention of:

        • receiving or obtaining benefit payments, or

        • retaining increased benefit payments.

      • Person received or retained benefit payments or increased benefit payments as a result of the intentional failure to disclose the change in circumstances.

    • BE ADVISED - you are NOT expected and it is generally NOT REASONABLE to expect you to properly understand the Rating schedules, VA policies, various case law decisions, and other medical aspects. So outside of an extreme case like Loss of use of a limb or Blindness - it would NOT be fraud to not report suspected improvement.

      • If you feel guilty please consider donating your money to a cause you find worthy. Raters SERIOUSLY have better things to do with their time (like rating Veterans who do not have benefits already) than fuss with you wanting to try to get reduced!

Reporting Suspected Fraud

If you suspect someone has committed/is committing fraud against the Department of Veterans Affairs you may report the suspected fraud to VAOIG by clicking HERE.