Last Update: 6/7/22 (Transmittal I-2-244)

A. Policy

For definitions of fraud and similar fault in regard to evidence in a claim(s), see Hearings, Appeals, and Litigation Law (HALLEX) manual I-1-3-15 B.

For definitions associated with administrative sanction cases, see HALLEX I-2-10-16.

For general information relating to redeterminations based on fraud or similar fault, see HALLEX I-1-3-25.

For general information relating to “non-redetermination cases” based on fraud or similar fault, see HALLEX I-1-3-26.


In a redetermination, an individual may appeal a determination or decision regarding whether the individual was entitled to disability benefits or eligible for supplemental security income as of the date of the original allowance. The individual may also appeal the decision to disregard evidence based on a reason to believe that fraud or similar fault was involved in the provision of that evidence.

B. Administrative Law Judge (ALJ) Responsibilities

When a case involves an issue of fraud or similar fault, the issues before an ALJ may include one or more of the following:

  • Whether certain evidence must be disregarded (HALLEX I-2-10-10);

  • Whether to impose administrative sanctions in the form of nonpayment of benefits (HALLEX I-2-10-16); and

  • Whether a prior final determination or decision should be reopened under the rules of administrative finality because it was obtained by fraud or similar fault (HALLEX I-2-9-65).


If an ALJ suspects fraud or criminal conduct that is not material to the issue(s) before the ALJ, the applicable instructions in HALLEX I-1-3 apply.


The disregarding of evidence based on a fraud or similar fault finding does not complete the adjudication of any claim for benefits. Unless a dismissal is appropriate, the ALJ must issue a favorable, partially favorable, or unfavorable decision on the claim by evaluating the remaining evidence. See HALLEX I-2-10-10.

C. Ex Parte Communications

ALJs will not attempt to contact or question an Office of the Inspector General (OIG) agent or witness unless HALLEX I-2-10-8 A applies.

However, there is no prohibition on ALJs consulting with other appropriate agency personnel about technical issues or questions of law or policy regarding information from OIG. Additionally, this instruction does not preclude a person or party from inquiring about the status of a case or asking routine questions about administrative functions or procedures.