I-1-3-30.Referring Non-Compliant Excluded Medical Sources of Evidence to the Office of the Inspector General

Last Update: 11/08/16 (Transmittal I-1-87)

If an excluded medical source of evidence does not include a written statement of exclusion (see Hearings, Appeals and Litigation Law manual I-2-5-15 and I-3-2-36) with evidence the source furnishes to the Social Security Administration (SSA) (whether directly or indirectly through a claimant, representative, or other individual or entity), and an administrative law judge (ALJ) or the Appeals Council (AC) knows or has sufficient reason or information to believe that the source is an excluded medical source, the ALJ, Hearing Office Director (HOD) or AC will report the source to the Office of the Inspector General (OIG) using the SSA-e8551 Fraud Entry Form. This electronic form can be found at: http://electronic8551.ssahost.ba.ssa.gov/(S(3oghkqtjmznkrapfwvd1dsac))/forms/e8551.aspx.

NOTE 1:

When referring an excluded medical source of evidence to OIG for not providing a written statement of exclusion, hearing operations staff or the AC will not delay case processing or adjudication unless otherwise instructed by OIG.

Examples of instances in which an ALJ or the AC may know or have sufficient reason or information to believe that a source should have included a written statement of exclusion with evidence the source furnished include:

  • The claimant or appointed representative informs the ALJ or the AC and provides objective, irrefutable proof that the source is an excluded medical source of evidence; or

  • The Office of Quality Review identifies the source as an excluded medical source of evidence as part of its pre-effectuation review process and informs the ALJ or the AC.

To fill out the SSA-e8551 for purposes of referring an excluded medical source of evidence to OIG, the ALJ, HOD, or the AC will follow the procedures in Program Operations Manual System (POMS) GN 04111.065, Preparation of the Electronic Form SSA-8551 (e8551), except as provided in POMS DI 23060.040.

NOTE 2:

The current SSA-e8551 form does not offer the option to choose an allegation related to an excluded medical source of evidence who fails to provide a written statement of exclusion. Without such an option, adjudicators are directed to choose the “FRAUDULENT MEDICAL EVIDENCE” selection and provide a summary of the allegations as discussed in POMS DI 23060.040A.2. If an adjudicator has reason to believe that the evidence was obtained through fraud or similar fault (FSF), the adjudicator must follow our FSF policies and refer the case to OIG as appropriate.