I-5-6-8.New York (September 30, 2016 Referral; NYIN)

Last Update: 4/5/19 (Transmittal I-5-600)

Table of Contents
I Purpose
II Background
III Hearing Level Procedures
IV AC Procedures
V Inquiries
Attachment 1 Dr. Escabi-Perez's Plea Agreement
Attachment 2 Dr. Escabi-Perez's Statement Under Penalty of Perjury Dated October 23, 2015
Attachment 3 OIG Section 1129(l) Referral
Attachment 4 Screening Worksheet
Attachment 5 Hearing Office Notice
Attachment 6 Appeals Council Notices
I Purpose
II Background
III Redetermination Procedures
IV Appeal Procedures
V Inquiries
Attachment 1 Plea Agreements
Attachment 2 Judgments
Attachment 3 OIG Section 1129(l) Referral
Attachment 4 Screening Sheet
Attachment 5 Redetermination Notice
I Purpose
II Background
III Hearing Level Procedures
IV AC Procedures
V Inquiries
Attachment 1 OIG Section 1129(l) Referrals
Attachment 2 Indictment
Attachment 3 Plea Agreement
Attachment 4 Screening Worksheet
Attachment 5 Hearing Office Notice
Attachment 6 Appeals Council Notices
I Purpose
II Background
III Hearing Office Procedures
IV Appeals Council Procedures
V Inquiries
Attachment 1 Referral Letter from New York County District Attorney's Office
Attachment 2 Indictment
Attachment 3 Plea Agreements
Attachment 4 Screening Sheet
Attachment 5 Hearing Office Notice
Attachment 6 Appeals Council Notice

Issued: March 16, 2018

Revised: April 5, 2019

Revised: March 13, 2020

I. Purpose

This Temporary Instruction advises employees in the Office of Hearing Operations (OHO) and the Office of Appellate Operations (OAO) in the Office of Analytics, Review, and Oversight (OARO) of the instructions for processing certain cases redetermined under Hearings, Appeals and Litigation Law (HALLEX) manual I-1-3-25. These instructions relate to plea agreements from four individuals who orchestrated a scheme to assist applicants in submitting applications containing false claims and evidence to the Social Security Administration (SSA) in order to obtain disability benefits. In addition to the four individuals who ran the scheme, many beneficiaries were also indicted for participating in the scheme. For detailed information about the fraud scheme, see the background section in HALLEX I-5-6-3 II.

These instructions pertain only to beneficiaries who were individually referred to SSA by the New York County District Attorney's Office (DA) in a letter dated September 30, 2016 (referral letter) and whose criminal cases have been dismissed without a plea deal or other admission or proof of guilt. In the referral letter, the DA outlined a coordinated scheme “to fabricate a psychiatric disability” and obtain unauthorized benefits for numerous individuals in New York City. The referral letter identified for SSA the individual cases at issue, all of which had Raymond Lavallee as the appointed representative, and applications and allegations matching those at issue in the fraudulent scheme. These cases are being redetermined because the beneficiaries were among those referred by the DA. The referral letter and guilty pleas from the four individuals who orchestrated the scheme trigger SSA's obligation under section 205(u) of the Social Security Act (Act) to redetermine the case and disregard certain evidence (identified below).

For processing instructions for beneficiaries who were not indicted in the scheme but were referred to SSA by the prosecuting attorney on February 25, 2014, see HALLEX I-5-6-3 and I-5-6-3A. For processing instructions for beneficiaries who pleaded guilty to knowingly participating in the scheme, see HALLEX I-5-6-4. For processing instructions for beneficiaries who were convicted at trial of fraudulently collecting disability benefits from SSA, see HALLEX I-5-6-9.

NOTE:

Nothing in these instructions precludes OHO or OAO staff or adjudicators from referring suspected instances of fraud or similar fault in accordance with HALLEX I-1-3-6 or I-1-3-9.

II. Background

Mr. Lavallee (an appointed representative), Thomas Hale (a disability consultant), Joseph Esposito (a retired New York City police officer), and John Minerva (a union official for the Detective Endowment Association) pleaded guilty to directing and assisting numerous individuals in creating and submitting fraudulent Social Security Disability Insurance (SSDI) applications from at least January 1, 1988 through December 18, 2013. Although the beneficiaries addressed in this instruction had their criminal cases dismissed without a plea deal or other admission or proof of guilt, the DA's referral letter and section 205(u) of the Act require that SSA redetermine the entitlement of each individual referred by the DA. By law, SSA must disregard evidence submitted by those involved in the fraudulent scheme when conducting those redeterminations.

The circumstances of the scheme were generally as follows: The four principal facilitators named above directed and assisted numerous beneficiaries on how to present false mental impairments and respond to agency questions or examinations in order to obtain benefits based on a mental impairment. Among other things, the facilitators helped beneficiaries fill out paperwork with fabricated evidence regarding activities of daily living and coached them on how to act and what to say during consultative examinations, administrative law judge (ALJ) hearings, and treatment sessions. Many of the beneficiaries cited the events of September 11, 2001 as the cause of their psychiatric condition(s). The beneficiaries visited psychiatrists or psychologists designated by one or more of the four named individuals to build a record of psychiatric treatment for a condition that would warrant an allowance for SSDI benefits. As the DA pointed out in the referral letter, “[t]he medical reports prepared by these doctors reached the same diagnostic conclusions” and “[i]nvariably, these doctors began treating their 'patients' approximately one year before the claimants submitted their SSDI applications.” Beneficiaries continued to receive treatment from these doctors after qualifying for benefits, frequently by phone. In return for services by the four named individuals, after an individual received past-due benefits, he or she made a cash payment to Mr. Lavallee, Mr. Hale, Mr. Esposito, or Mr. Minerva amounting to 14 months' of benefits.

Because it is implicated by the DA's referral letter, the indictment of the four principal facilitators and numerous other individual beneficiaries, and the plea agreements from Mr. Lavallee, Mr. Hale, Mr. Esposito, and Mr. Minerva, under section 205(u) of the Act, SSA must disregard the following evidence dated between January 1, 1988 and December 18, 2013:

  • Any evidence regarding a mental impairment submitted by one of the four principal facilitators (Mr. Lavallee, Mr. Hale, Mr. Esposito, and Mr. Minerva); and

  • Medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul.

NOTE:

The redetermined claims involve title II benefits only. If OHO or OAO staff or adjudicators find an identified claim that involves title XVI, section 1631(e)(7) of the Act is also implicated and additional instruction will be needed. If this situation arises, OHO or OAO staff or adjudicators will refer the case through normal management channels for additional instruction before processing the case.

Mr. Lavallee was disqualified from representing claimants before SSA, effective December 12, 2014.

III. Hearing Office Procedures

A. Redeterminations Under Section 205(u) of Closed Hearing Level Cases

The Albany Hearing Office will process all redeterminations of closed hearing level cases.

1. Screening Closed Cases

Based on the DA's referral letters, indictment, and plea agreements from the four principal facilitators, under section 205(u) of the Act, SSA must redetermine cases identified by the DA, and, in doing so, disregard certain evidence. Designated adjudicators will screen all closed hearing level cases in which a beneficiary received a favorable decision and the Appeals Council (AC) did not exercise its authority to issue a decision. Adjudicators will use the screening sheet in Attachment 4 for this purpose.

In sum, the designated adjudicators will:

  • Establish a new case in the Case Processing and Management System (CPMS) with the case characteristic “NYIN” (New York Indicted), manually establishing the case if it cannot be reactivated;

  • Disregard the following evidence dated between January 1, 1988 and December 18, 2013: Any evidence regarding a mental impairment submitted by one of the four principal facilitators (Mr. Lavallee, Mr. Hale, Mr. Esposito, and Mr. Minerva); and medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul;

  • Consider the claim(s) only through the date of the final and binding hearing level decision on the beneficiary's application for benefits (i.e., the original allowance date); and

  • Make an initial assessment regarding whether, after disregarding the evidence identified above, the ALJ decision is supported by a preponderance of the evidence in the record.

NOTE:

When determining whether the initial assessment is supported by a preponderance of the evidence in the record, the ALJ will apply the listings that were in effect at the time of the original favorable decision. SSA may have updated the listings since the time of the original favorable decision. For a comprehensive list of obsolete listings, see Program Operations Manual System (POMS) DI 34100.000.

a. Favorable Decision Warranted

If, after disregarding the categories of evidence described above, the designated adjudicator determines the favorable decision is supported by a preponderance of the remaining evidence, the adjudicator will:

  • Associate the completed screening sheet in the Private section of the claim(s) file;

  • Include a copy of the referral letter (Attachment 1), indictment (Attachment 2), plea agreements (Attachment 3), and any other applicable document. In paper cases, staff will add the referral letter, indictment, plea agreements, and any other applicable document to Part B- Jurisdiction Documents/Notices (red tab) of the claim(s) file. In electronic cases, staff will upload the referral letter, indictment, plea agreements, and any other applicable document using document type 7011-Misc. Jurisdictional Documents/Notices;

  • Complete a form SSA-5002, “Report of Contact,” indicating that the case was redetermined, identifying the evidence that was disregarded, and providing a brief summary of why a fully favorable decision is still warranted (associating the form in Part A- Payment Documents/Decision of the claim(s) file);

  • Add a message in eView (if an electronic case) indicating that a redetermination has been completed;

  • Document the redetermination in a Remark in CPMS; and

  • Close the CPMS record using the special dismissal code “SPDI.”

b. Prior Decision Unsupported

If, after disregarding the categories of evidence described above, the prior favorable decision is unsupported by a preponderance of the remaining evidence of record, the case will be processed using the remaining instructions in III.A.2. through III.A.9. below.

If not already part of the record, the hearing office (HO) will add a Possible Fraud or Similar Fault flag in eView or attach the flag to the front of a paper claim(s) file.

Additionally, if not already part of the record, the HO will add a copy of the DA referral letter (Attachment 1), indictment (Attachment 2), plea agreements (Attachment 3), and any other applicable document. In paper cases, staff will add the appropriate referral letter, indictment, plea agreements, and any other applicable document to Part B- Jurisdiction Documents/Notices (red tab) of the claim(s) file. In electronic cases, staff will upload the appropriate DA referral letter, indictment, plea agreements, and any other applicable document using document type 7011-Misc. Jurisdictional Documents/Notices to Part B- Jurisdictional Document/Notices (red tab) of the claim(s) file.

2. Notice to Beneficiary

When a new decision is needed after screening, the HO will send the one-time notice in Attachment 5 to the beneficiary. HO staff will add a copy of the notice to Part E- Disability Related Development and Documentation (Blue Tab) of the claim(s) file.

If the beneficiary submits rebuttal evidence, adjudicators will evaluate the evidence using the applicable instruction(s) in III.A.3. below.

3. Evidence

a. Evidence From Discredited Source

In conducting a redetermination under section 205(u) of the Act, the Commissioner must disregard evidence if there is reason to believe that fraud or similar fault was involved in providing the evidence. As a result of the facts stated in the DA's referral letter, the indictment against the four principal facilitators and numerous other individuals, and the facts admitted by the four principal facilitators responsible for the scheme, adjudicators must disregard the following evidence, dated between January 1, 1988 and December 18, 2013:

  • Any evidence regarding a mental impairment submitted by one of the four principal facilitators (Mr. Lavallee, Mr. Hale, Mr. Esposito, and Mr. Minerva); and

  • Medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul.

NOTE:

Because the DA's referral letter and plea agreements are related solely to allegations regarding mental impairments, adjudicators will consider any evidence regarding an alleged physical impairment(s), even if that evidence would be otherwise disregarded (e.g., submitted by one of the four convicted individuals).

b. Considering and Developing Other Evidence

In contrast to the statutory mandate to disregard the categories of evidence submitted by the facilitators or doctors identified above based on the DA's referral letter, indictment, and associated plea agreements, the ALJ will use the procedures in SSR 16-3p: Titles II and XVI: Evaluation of Symptoms in Disability Claims.

NOTE:

In some cases, it may also be appropriate to disregard under section 205(u) of the Act evidence provided by someone who is not one of the facilitators or doctors identified above in these instructions. For example, if a physician treating a physical impairment relies on evidence regarding treatment for mental impairments from one of the four principal facilitators or one of the two doctors listed in III.A.1. above, adjudicators must disregard the parts of the physician's report relying on the evidence from those facilitators or doctors, or, when based solely on the evidence from those facilitators or doctors, the entire document. When reliance on evidence from those facilitators or doctors is unclear, adjudicators will assign appropriate weight to the evidence given the circumstances of the case.

The ALJ will consider any evidence the beneficiary that is not from the facilitators or doctors involved in the fraudulent scheme and is new, material, and related to the limited period at issue as defined in this instruction, even if the evidence relates to a mental impairment. See HALLEX I-2-6-58 A and I-2-5-13. For example, if the beneficiary submits evidence of an impairment that existed at the time of his or her original allowance, but did not allege it on his or her application, the ALJ will consider that evidence. Additionally, there are circumstances when evidence that post-dates the original decision will reasonably relate to the time period adjudicated by the ALJ.

Generally, the ALJ will not develop evidence in cases being redetermined under sections 205(u) of the Act. See SSR 16-1p: Titles II and XVI: Fraud and Similar Fault Redeterminations Under Sections 205(u) and 1631(e)(7) of the Social Security Act, section C.3. However, the ALJ will obtain another copy of evidence if received evidence is missing pages or is otherwise incomplete, and the evidence is new, material, and related to the period at issue. Additionally:

  • The ALJ may obtain medical expert or vocational expert evidence as needed.

  • If a beneficiary requests assistance in developing records that he or she indicates are new, material, and related to the period at issue, and the record does not show that SSA previously made every reasonable effort to develop the same information, the ALJ will assist the beneficiary in obtaining the evidence.

  • If the ALJ finds it necessary to develop new sources for the period at issue, the ALJ may develop the evidence at its discretion. However, on the form SSA-827, “Authorization to Disclose Information to the Social Security Administration (SSA),” that accompanies the request for information, the ALJ will specifically limit the requested information to the time period previously adjudicated.

c. Evidence of New Impairment Submitted

If the beneficiary submits evidence of a new impairment that does not relate to the period at issue, the ALJ will not consider or develop the evidence of the new impairment. See SSR 16-1p, section A.8.

NOTE 1:

If the additional evidence shows a new critical or disabling condition is present, HO staff will verbally notify the beneficiary that he or she may file a new application. See HALLEX I-1-10-1 C for the definition of “new critical or disabling condition.” The HO staff or manager who notifies the beneficiary will document the conversation on a form SSA-5002, provide a copy to the beneficiary, and associate the form in Part E- Disability Related Development and Documentation (blue tab) of the claim(s) file.

NOTE 2:

If the beneficiary files a new application, the ALJ will not accept an escalated claim or consolidate the redetermination claim with the new application (see POMS DI 12045.010A). The claim(s) cannot be consolidated because there is no “common issue” as defined in POMS (i.e., there are different issues and time period involved in the redetermination claim and the subsequent application).

4. Exhibiting and Marking Issues

Disregarded evidence must remain in the claim(s) file. In a closed case, disregarded evidence will already be exhibited, so the ALJ will ensure that evidence submitted by the facilitators or doctors involved in the fraudulent scheme is clearly identified. In electronic cases, the ALJ will ensure staff noted the information as “DISREGARDED-FSF” in the Notes in eView. In a paper claim(s) file, the AC will ensure staff added “DISREGARDED-FSF” on the first page of the information with the number of pages, and on each subsequent page. To illustrate, a 2-page submission that the ALJ disregards would be marked as follows: page 1 “DISREGARDED-FSF 1/2” and page 2 “DISREGARDED-FSF 2/2.”

5. Notice of Hearing Language

To give notice regarding the statutory basis of the redetermination, the period at issue, and the issues relating to disregarded evidence, the ALJ must include specific language in the “Issues I Will Consider” section of the notice of hearing. The Office of the Chief Administrative Law Judge (OCALJ) will provide appropriate language to the ALJ.

6. Applicable Law

In processing cases redetermined under sections 205(u) and 1631(e)(7) of the Act, the ALJ must review and apply the listings in the Listing of Impairments (20 CFR, Part 404, Subpart P, Appendix 1) that were in effect at the time of the original favorable decision.

NOTE:

SSA may have updated the listings since the time of the original favorable decision. For a comprehensive list of obsolete listings, see POMS DI 34100.000.

While the ALJ must apply the listings that were in effect at the time of the original favorable decision, the ALJ and OHO staff will apply the national uniformity regulations regardless of when the original favorable decision was issued. See 20 CFR 404.900-951 and 416.1400-1451.

7. Decision Language

Once the beneficiary has been given notice of the redetermination, the ALJ must issue a decision in a redetermination case. Under no circumstances can the ALJ dismiss the request for hearing, even if the beneficiary does not appear at the time and place of the redetermination hearing. If the beneficiary fails to appear and does not establish good cause, or waives the right to appear at the hearing, the ALJ will issue a decision on the record.

NOTE:

Assisting HO staff must still follow the contact procedures in HALLEX I-2-3-15 and I-2-3-20 when providing notice of hearing. If the beneficiary does not appear at the time and place of the redetermination hearing, the ALJ and assisting HO staff will use the procedures in HALLEX I-2-4-25 to determine whether it is necessary to develop good cause for the failure to appear (but cannot dismiss the request for hearing after doing so).

The ALJ will specifically note in the decision:

  • Under section 205(u) of the Social Security Act, SSA must redetermine an individual's entitlement to monthly insurance benefits if there is reason to believe that fraud or similar fault was involved in the individual's application for such benefits, and, in so doing, disregard evidence when there is reason to believe fraud or similar fault was involved in providing that evidence. The New York County District Attorney's Office and the Office of the Inspector General of the Social Security Administration conducted an extensive criminal investigation that resulted in the criminal indictment and conviction of Raymond Lavallee, Thomas Hale, Joseph Esposito, and John Minerva, who admitted to conducting a scheme to make false statements or other representations to the Social Security Administration in order to obtain fraudulent benefits for others. Numerous individual beneficiaries have also been indicted and convicted in connection with the DA's investigation;

  • The DA referred this case to SSA as one where Mr. Lavallee was the beneficiary's attorney representative and the facts of the case are similar to those involved in the fraudulent scheme. The file contains evidence from one or more of the principal facilitators regarding a mental impairment(s) alleged in the case that SSA used to find the beneficiary disabled or from one of the doctors the DA identified as having been involved in the scheme. Therefore, the ALJ determined whether the beneficiary was entitled to benefits on or before [Date of Prior Favorable Decision], the date SSA initially allowed the claim(s). By law, SSA was not able to consider the following evidence dated between January 1, 1988 and December 18, 2013: any evidence regarding a mental impairment submitted by one of the four principal facilitators; and medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul;

  • The ALJ considered all remaining evidence that related to the period on or before the original allowance date; and

  • [If favorable] The ALJ determined there was sufficient evidence supporting a finding of disability as of [Date of Prior Hearing Decision]; or

  • [If unfavorable] The ALJ determined that there was insufficient evidence supporting a finding of disability as of [Date of Prior Hearing Decision]. Therefore, the beneficiary's entitlement to benefits is terminated, and SSA will treat the benefits the beneficiary previously received as overpayments. The provisions of Subpart F-Overpayments, Underpayments, Waiver of Adjustment or Recovery of Overpayments, and Liability of a Certifying Officer apply. (20 CFR Ch III Part 404 Subpart F). The beneficiary may request that the overpayment be waived, and SSA will consider such a request under these rules.

8. Notification to Program Service Center

The Northeastern Program Service Center (NEPSC) is handling all payment matters relating to redeterminations of New York cases. When a redetermined decision is issued, regardless of whether it is favorable or unfavorable, the HO must notify the NEPSC via email at NY ARC PCO DPB NEPC. The HO will use the subject line “OHO redetermination decision-NY” and include the following message in the text of the email:

The Office of Hearing Operations has issued a redetermination decision for [beneficiary's name (SSN: ###-##-####)]. The [unfavorable/favorable] decision is [attached/in eView]. Please take any necessary action to [cease/initiate] payment in this case and notify any other PSC that may be affected by this action. Thank you.

NOTE:

Sending an email to the NEPSC is critical to ensure these decisions are properly and promptly effectuated. For example, if a favorable decision is issued, CPMS will generate an automated alert to the Program Service Center with jurisdiction over the claimant's SSN. The NEPSC must be notified immediately so it can notify the other Program Service Center of the change in jurisdiction.

Send paper folders requiring further action by the NEPSC to:

Social Security Administration
Northeastern Program Service Center
PO Box 319100
Jamaica, NY 11431-9819

9. Representative Fee Issues

For the reasons explained in the NOTE below (i.e., multiple representative situation), the ALJ must disapprove any newly appointed representative's fee agreement if issuing a favorable decision. See HALLEX I-1-2-12.

Any appointed or previously appointed representative can submit a fee petition for services he or she provided, and the ALJ will use the applicable procedures in HALLEX I-1-2 for evaluating these requests and determining a reasonable fee. However, if a representative submitted a contingent fee contract, the representative is not entitled to request a fee unless a favorable decision is issued on the redetermination proceedings. See HALLEX I-1-2-51.

NOTE:

Although Mr. Lavallee is now disqualified from serving as a representative before SSA, he could submit a fee petition in a case for services provided before the date of his disqualification. When evaluating any such fee petition, the AC may consider Mr. Lavallee's plea agreement when reviewing the services provided and the results achieved. For authority and additional instruction, see HALLEX I-1-1-57.

Issues relating to any authorized fee to Mr. Lavallee during the original adjudication are outside the scope of this instruction. However, if Mr. Lavallee submits a fee petition when a fee was previously authorized, please refer the issue to OCALJ for additional instruction.

B. Handling Requests for Hearing When a Case is Redetermined at Another Administrative Level

The following processing requirements apply when a beneficiary appeals a redetermination action based on fraud or similar fault. The Albany Hearing Office (HO) will be handling all requests for hearing when a case is redetermined at another administrative level.

Upon receipt of the request for hearing, designated HO staff will establish a new case in CPMS with the case characteristic “NYIN” (New York Indicted).

1. Notice to Beneficiary- Acknowledgement Language

HOs will include the following language in the acknowledgement of the request for hearing when the claim(s) was redetermined at the initial or reconsideration levels:

Your file contains information from an investigation by the New York County District Attorney's Office and the Office of the Inspector General of the Social Security Administration. The information concerns the criminal indictment and conviction of Raymond Lavallee, Thomas Hale, Joseph Esposito, and John Minerva, who admitted to conducting a scheme to make false statements or other representations to the Social Security Administration in order to fraudulently obtain benefits for others. You will see this evidence, as well as the other evidence in your file, if you decide to look at the file before the hearing or on the date of the hearing. We will provide more information in a later notice regarding the issues we will decide at your hearing.

2. Period of Adjudication

The ALJ will consider the claim(s) only through the date of the final and binding determination or decision on the beneficiary's application for benefits (i.e., the original allowance date).

NOTE:

If the beneficiary submits objective evidence showing a critical or disabling impairment with onset after the period at issue, see III.A.4.c. below.

3. Applicable Law

In processing cases redetermined under sections 205(u) and 1631(e)(7) of the Act, ALJs must review and apply the listings in the Listing of Impairments (20 CFR, Part 404, Subpart P, Appendix 1) that were in effect at the time of the original favorable determination.

NOTE:

SSA may have updated the listings since the time of the original favorable determination. For a comprehensive list of obsolete listings, see POMS DI 34100.000.

While the ALJ must apply the listings that were in effect at the time of the original favorable determination, the ALJ and OHO staff will apply the national uniformity regulations regardless of when the original favorable determination was issued. See 20 CFR 404.900-951 and 416.1400-1451.

4. Evidence

a. Previously Disregarded Evidence

In a redetermination case, a beneficiary may appeal a determination regarding whether he or she was entitled to benefits on the date he or she was originally allowed. However, the beneficiary may not appeal the agency's statutory mandate under section 205(u) of the Act to conduct redeterminations in these cases or to disregard evidence submitted by the facilitators or doctors identified in these instructions.

When a beneficiary appeals a previously redetermined claim, ALJs may not reconsider whether to disregard evidence submitted by those facilitators or doctors identified in these instructions. However, if during a review under section 205(u) of the Act, an ALJ finds that evidence was disregarded incorrectly (e.g., information about a physical impairment was incorrectly disregarded or evidence dated outside the specified timeframes was disregarded), the ALJ will use the information in SSR 16-2p, as well as HALLEX I-1-3-15 and I-2-10-10, to determine whether a preponderance of the evidence supports disregarding the evidence based on fraud or similar fault. If it does not, the ALJ will add the information back into the record and consider the evidence when adjudicating the claim.

Adjudicators may also consider any new evidence the beneficiary offers on appeal as outlined in HALLEX I-2-6-58 regarding alleged physical impairment(s), or evidence of an additional mental or physical impairment existing at the time of his or her original application that the beneficiary did not previously allege.

NOTE:

The ALJ will also use the procedures in SSR 16-2p, as well as HALLEX I-1-3-15 and I-2-10, when determining whether to disregard additional evidence due to fraud or similar fault, in addition to the categories of evidence identified above. If the ALJ disregards additional evidence based on fraud or similar fault, the ALJ must clearly address the evidence and explain why it was disregarded in the decision. If the ALJ makes independent findings regarding fraud and similar fault on evidence not already disregarded, the ALJ will notify the beneficiary that he or she may appeal that particular finding.

b. Considering and Developing Evidence

Generally, an ALJ will not develop evidence in cases being redetermined under section 205(u) of the Act. The ALJ will, however, consider any evidence submitted by the beneficiary that is not involved in the fraudulent scheme and is new, material, and related to the limited period at issue as defined in this instruction. See HALLEX I-2-6-58 A and I-2-5-13.

The ALJ will obtain another copy of received evidence that is missing pages or is otherwise incomplete, and the evidence is new, material, and related to the period at issue. Additionally:

  • The ALJ may obtain medical expert or vocational expert evidence as needed.

  • If a beneficiary requests assistance in developing records that he or she indicates are new, material, and related to the period at issue, and the records do not show that SSA previously made every reasonable effort to develop the same evidence, the ALJ will assist the beneficiary in obtaining the evidence.

  • If the ALJ finds it necessary to develop new sources for the period at issue, the ALJ may develop at his or her own discretion. However, on the form SSA-827 that accompanies the request for information, the ALJ will specifically limit the requested information to the time period being adjudicated.

c. Evidence of New Impairment Submitted

If the beneficiary submits evidence of an impairment that existed at the time of his or her original allowance, but was not alleged on his or her application, the ALJ will consider that evidence as outlined in HALLEX I-2-6-58.

If the beneficiary submits evidence of a new impairment unrelated to those alleged in his or her application, with an onset date after the original allowance date, the ALJ will not consider or develop the evidence of the new impairment. However, in a redetermination scenario under section 205(u) of the Act, SSR 11-1p does not preclude a beneficiary from filing a new application.

NOTE 1:

If the evidence shows a new critical or disabling condition is present, or if the beneficiary raises the issue of filing a new application, HO staff will inform the beneficiary that he or she may file a new application. See HALLEX I-1-10-1 C for the definition of “new critical or disabling condition.” If HO staff verbally informs the beneficiary that he or she may file a new application, hearing office staff will document the conversation on a form SSA-5002, provide a copy to the beneficiary, and associate the form in Part E- Disability Related Development and Documentation (blue tab) of the claim(s) file.

NOTE 2:

If a new application is filed, the ALJ will not accept an escalated claim or consolidate the redetermination claim with the new application (see POMS DI 12045.010A). The claim(s) cannot be consolidated because there is no “common issue” as defined in POMS (i.e., there are different issues and time period involved in the redetermination claim and the subsequent application).

5. Notice of Hearing Language

To give notice regarding the statutory basis of the redetermination, the period at issue, and the issues relating to disregarded evidence, the ALJ must include specific language in the “Issues I Will Consider” section of the notice of hearing. OCALJ will provide appropriate language to the ALJ.

6. Decision Language

The ALJ will specifically note in the decision that:

  • Under section 205(u) of the Act, SSA must redetermine entitlement to monthly insurance benefits and disregard evidence when there is reason to believe fraud or similar fault was involved in that individual's application for benefits. The New York County District Attorney's Office and SSA's Office of the Inspector General conducted an extensive criminal investigation that resulted in the criminal indictment and conviction of Raymond Lavallee, Thomas Hale, Joseph Esposito, and John Minerva.-, These individuals admitted to conducting a scheme to make false statements or other representations to SSA in order to fraudulently obtain benefits for others. Numerous individual beneficiaries have also been indicted and convicted in connection with the DA's investigation.

  • The DA referred this case to SSA as one in which Mr. Lavallee was the beneficiary's attorney representative and the facts of the case are similar to those involved in the fraudulent scheme. The file contains evidence from one or more of the principal facilitators or the two doctors the DA identified as participating in the scheme regarding a mental impairment(s) alleged in the case that SSA used to find the beneficiary disabled.

  • The redetermination was completed at another administrative level, the beneficiary disagreed with the determination, and the beneficiary requested a hearing before an ALJ;

  • Based on the beneficiary's request for a hearing, the ALJ determined whether the beneficiary was entitled to benefits on or before [Date of Prior Determination], the date SSA initially allowed the claim(s). By law, SSA was not able to consider the following evidence dated between January 1, 1988 and December 18, 2013: any evidence regarding a mental impairment submitted by one of the four principal facilitators; and medical evidence from two psychiatrists identified by the DA in the referral letter as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul;

  • The ALJ considered all remaining evidence that related to the period on or before the original allowance date; and

  • [If favorable] The ALJ determined there was sufficient evidence supporting a finding of disability as of [Date of Award Notice]; or

  • [If unfavorable] The ALJ determined that there was insufficient evidence supporting a finding of disability as of [Date of Award Notice]. Therefore, the beneficiary's entitlement to benefits is terminated, and SSA will treat the benefits the beneficiary previously received as overpayments. The provisions of Subpart F-Overpayments, Underpayments, Waiver of Adjustment or Recovery of Overpayments, and Liability of a Certifying Officer apply. (20 CFR Ch III Part 404 Subpart F). The beneficiary may request that the overpayment be waived, and SSA will consider such a request under these rules.

7. Notification to Program Service Center

As noted previously, the NEPSC is handling all payment matters relating to redeterminations of New York cases. If an ALJ issues a favorable decision after reviewing a previously redetermined case, the HO must notify the NEPSC via email at NY ARC PCO DPB NEPC. The HO will use the subject line “Change in prior redetermination case-NY” and include the following message in the text of the email:

An ALJ has issued a favorable decision on a New York case that was redetermined under section 205(u) of the Social Security Act at the initial or reconsideration level. The beneficiary is [beneficiary's name (SSN: ###-##-####)]. The favorable decision is [attached/in eView]. Please take any necessary action to initiate payment in this case and notify any other PSC that may be affected by this action. Thank you.

NOTE:

Sending an email to the NEPSC is critical to ensure these decisions are properly and promptly effectuated. For example, if an ALJ issues a favorable decision, CPMS will generate an automated alert to the Program Service Center with jurisdiction over the claimant's SSN. The NEPSC must be notified immediately so it can notify the other Program Service Center of the change in jurisdiction.

Send paper folders requiring further action by the NEPSC to:

Social Security Administration
Northeastern Program Service Center
PO Box 319100
Jamaica, NY 11431-9819

8. Representative Fee Issues

For the reasons explained in the NOTE below (i.e., multiple representative situation), the ALJ must disapprove any appointed representative's fee agreement if issuing a favorable decision. See HALLEX I-1-2-12.

Any appointed or previously appointed representative can submit a fee petition for services he or she provided, and the ALJ will use the applicable procedures in HALLEX I-1-2 for evaluating these requests and determining a reasonable fee. However, if a representative submitted a contingent fee contract, the representative is not entitled to request a fee unless a favorable decision is issued on the redetermination proceedings. See HALLEX I-1-2-51.

NOTE:

Although Mr. Lavallee is now disqualified as a representative, he could submit a fee petition in a case for services provided before the date of his disqualification. When evaluating any such fee petition, the ALJ may take Mr. Lavallee's plea agreement into consideration when reviewing the services provided and the results achieved. For authority and additional instruction, see HALLEX I-1-1-57.

Issues relating to any authorized fee to Mr. Lavallee during the original adjudication are outside the scope of this instruction. However, if Mr. Lavallee submits a fee petition in a case in which a fee was previously authorized, please refer the issue to OCALJ for additional instructions.

IV. Appeals Council Procedures

A. Redeterminations of Closed Cases by the AC

Based on the guilty pleas of the four principal facilitators, indictment, and DA referral letter, under section 205(u) of the Social Security Act, SSA must redetermine the disability claim(s) for certain beneficiaries and, in doing so, disregard certain evidence.

1. Screening Closed Cases

The Appeals Council was provided a list of previously adjudicated cases that require redeterminations under section 205(u) of the Act. OAO staff will use the Bureau Protest workload to establish a new AC case in the Appeals Review Processing System (ARPS) with the case characteristic “NYIN” (New York Indicted). Designated adjudicators will screen closed cases in which the Appeals Council issued a favorable decision that may need to be redetermined based on fraud or similar fault.

In sum, the designated adjudicators will:

  • Disregard the following evidence dated between January 1, 1988 and December 18, 2013: any evidence regarding a mental impairment submitted by one of the four principal facilitators (Mr. Lavallee, Mr. Hale, Mr. Esposito, and Mr. Minerva), and medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul;

  • Consider the claim only through the date of the final and binding AC decision on the beneficiary's application for benefits (i.e., the original allowance date); and

  • Make an initial assessment regarding whether the AC decision is supported by a preponderance of the evidence even after disregarding the evidence identified above.

NOTE:

When determining whether the initial assessment is supported by a preponderance of the evidence in the record, the AC will apply the listings that were in effect at the time of the original favorable decision.

a. Favorable Decision Warranted

If, after disregarding the categories of evidence described above, the designated adjudicators determine that a favorable decision is still warranted based on the remaining evidence, the adjudicators will:

  • Associate the completed screening sheet (Attachment 4) in the Private section of the claim(s) file;

  • Include a copy of the referral letter (Attachment 1),indictment (Attachment 2), plea agreements (Attachment 3), and any other applicable document in the claim(s) file. In paper cases, staff will add the DA's referral letter and any other applicable document to Part B- Jurisdiction Documents/Notices (red tab) of the claim(s) file. In electronic cases, staff will upload the DA's referral letter, indictment, plea agreements, and any other applicable document using document type 7011-Misc. Part B Jurisdictional Documents/Notices;

  • Complete form SSA-5002, Report of Contact, indicating that the case was redetermined, identifying the evidence that was disregarded, and providing a brief summary of why a favorable decision is still warranted (and associate the form with the claim(s) file);

  • Add a message in eView (if an electronic case) indicating a redetermination has been completed;

  • Document the redetermination in a Remark in ARPS; and

  • Close the ARPS record using the final action code “DENY.”

b. Prior Decision Unsupported

If, after disregarding the categories of evidence described above, the prior decision is unsupported based on the remaining evidence, the case will be processed using the remaining instructions in section IV.A.2 through IV.A.8. below.

If not already in the record, staff will add a Possible Fraud or Similar Fault flag in eView or attach the flag to the front of a paper claim(s) file.

Additionally, if it is not already part of the record, staff will add a copy of the DA's September 30, 2016 referral letter (Attachment 1), indictment (Attachment 2), plea agreements (Attachment 3), and any other applicable document. In paper cases, staff will add the September 30, 2016 referral letter, plea agreements, and any other applicable document to Part B- Jurisdiction Documents/Notices (red tab) of the claim(s) file. In electronic cases, staff will upload DA's referral letter, plea agreements, and any other applicable document using document type 7011-Misc. Jurisdictional Documents/Notices to Part B- Jurisdictional Document/Notices (red tab) of the claim(s) file.

2. Notice to Beneficiary

The AC will send the appropriate notice in Attachment 5 to any affected beneficiary to notify the beneficiary of the proposed action. Staff will add a copy of the notice to Part E- Disability Related Development and Documentation of the claim(s) file.

3. Evidence

a. Evidence From Discredited Source

In conducting a redetermination under section 205(u) of the Act, the Commissioner must disregard evidence if there is reason to believe that fraud or similar fault was involved in providing the evidence. As a result of the facts stated in the DA's referral letter, the indictment against the four principal facilitators and numerous other individuals, and the facts admitted by the four principal facilitators responsible for the scheme, adjudicators must disregard the following evidence, dated between January 1, 1988 and December 18, 2013:

  • Any evidence regarding a mental impairment submitted by one of the four principal facilitators (Mr. Lavallee, Mr. Hale, Mr. Esposito, and Mr. Minerva); and

  • Medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul.

NOTE:

Because the DA's referral letter and plea agreements are related solely to allegations regarding mental impairments, adjudicators will consider any evidence regarding an alleged physical impairment(s), even if that evidence would be otherwise disregarded (e.g., submitted by one of the four principal facilitators).

b. Considering and Developing Other Evidence

In contrast to the statutory mandate to disregard the categories of evidence submitted by the facilitators or doctors identified above based on the DA's referral letter and associated plea agreements, the AC will use the procedures in SSR 16-3p.

NOTE:

In some cases, it may also be appropriate to disregard under section 205(u) of the Act evidence provided by someone who is not one of the facilitators or doctors identified above in these instructions. For example, if a physician treating a physical impairment relies on evidence regarding treatment for mental impairments from one of the four principal facilitators or one of the two doctors listed in IV.A.3.a. above, adjudicators must disregard the parts of the physician's report relying on the evidence from those facilitators or doctors, or, when based solely on the evidence from those facilitators or doctors, the entire document. When reliance on evidence from those facilitators or doctors is unclear, adjudicators will assign appropriate weight to the evidence given the circumstances of the case.

The AC will evaluate any evidence the beneficiary submits as outlined in HALLEX I-3-3-6 that is not from the facilitators or doctors involved in the fraudulent scheme and is new, material, and related to the period at issue, even if the evidence relates to a mental impairment (with the limited period at issue as defined in this instruction). For example, if the beneficiary submits evidence of an impairment that existed at the time of his or her original allowance, but did not allege it on his or her application, the AC will consider that evidence. Additionally, there are circumstances when evidence that post-dates the original AC or ALJ decision will reasonably relate to the time period adjudicated by the AC.

Generally, the AC will not develop evidence in cases being redetermined under sections 205(u) of the Act. See SSR 16-1p, section C.3. However, the AC will obtain another copy of evidence if received evidence is missing pages or is otherwise incomplete, and the evidence is new, material, and related to the period at issue. Additionally:

  • If a beneficiary requests assistance in developing records that he or she indicates are new, material, and related to the period at issue, and the record does not show that SSA previously made every reasonable effort to develop the same information, the AC will assist the beneficiary in obtaining the evidence.

  • If the AC finds it necessary to develop new sources for the period at issue, the AC may develop the evidence at its discretion. However, on the form SSA-827 that accompanies the request for information, the AC will specifically limit the requested information to the time period previously adjudicated.

c. Evidence of New Impairment Submitted

If the beneficiary submits evidence of a new impairment that does not relate to the period at issue, the AC will not consider or develop the evidence of the new impairment. See SSR 16-1p, section A.8.

NOTE 1:

If the additional evidence shows a new critical or disabling condition is present, OAO staff will verbally notify the beneficiary or representative, if any, that he or she may file a new application. See HALLEX I-1-10-1 C for the definition of “new critical or disabling condition.” The OAO staff or manager who notifies the beneficiary or representative will document the conversation on a form SSA-5002, provide a copy to the beneficiary, and associate the form in Part E- Disability Related Development and Documentation (blue tab) of the claim(s) file.

NOTE 2:

Irrespective of the different issue and time periods involved in a redetermination claim and any possible subsequent application, the AC generally does not accept requests to escalate claims or consolidate claims at the AC level. See HALLEX I-3-1-30.

4. Exhibiting and Marking Issues

Disregarded evidence must remain in the claim(s) file. In a closed case, disregarded evidence will already be exhibited, so the AC will ensure that evidence submitted by the facilitators or doctors involved in the fraudulent scheme is clearly identified. In electronic cases, the AC will ensure staff noted the information as “DISREGARDED-FSF” in the Notes in eView. In a paper claim(s) file, the AC will ensure staff added “DISREGARDED-FSF” on the first page of the information with the number of pages, and on each subsequent page. To illustrate, a 2-page submission that the AC disregards would be marked as follows: page 1 “DISREGARDED-FSF 1/2” and page 2 “DISREGARDED-FSF 2/2.”

5. Applicable Law

In processing cases redetermined under sections 205(u) and 1631(e)(7) of the Act, the AC must review and apply the listings in the Listing of Impairments (20 CFR, Part 404, Subpart P, Appendix 1) that were in effect at the time of the original favorable decision.

NOTE:

SSA may have updated the listings since the time of the original favorable decision. For a comprehensive list of obsolete listings, see POMS DI 34100.000.

While the AC must apply the listings that were in effect at the time of the original decision, the AC and OAO staff will apply the national uniformity regulations regardless of when the original favorable decision was issued. See 20 CFR 404.970-979 and 416.1470-1479.

6. Decision Language

Once the beneficiary has been given notice of the redetermination, the AC must either remand the claim(s) to an ALJ for further development or issue a fully favorable decision in a redetermination case. The AC will only issue a decision if, after giving the beneficiary or recipient the notice of redetermination, the AC determines a fully favorable decision is warranted based on contentions or additional evidence that is new, material, and there is a reasonable probability that the additional evidence would change the outcome of the decision. See HALLEX I-3-3-6 C.

The AC will specifically note in a decision:

  • Under section 205(u) of the Social Security Act, SSA must redetermine an individual's entitlement to monthly insurance benefits if there is reason to believe that fraud or similar fault was involved in the individual's application for such benefits, and, in so doing, disregard evidence when there is reason to believe fraud or similar fault was involved in providing that evidence. The New York County District Attorney's Office and the Office of the Inspector General of the Social Security Administration conducted an extensive criminal investigation that resulted in the criminal indictment and conviction of Raymond Lavallee, Thomas Hale, Joseph Esposito, and John Minerva, who admitted to conducting a scheme to make false statements or other representations to the Social Security Administration in order to obtain fraudulent benefits for others. Numerous individual beneficiaries have also been indicted and convicted in connection with the DA's investigation;

  • The DA referred this case to SSA as one where Mr. Lavallee was the beneficiary's attorney representative and the facts of the case are similar to those involved in the fraudulent scheme. The file contains evidence from one or more of the principal facilitators regarding a mental impairment(s) alleged in the case that SSA used to find the beneficiary disabled or from one of the doctors the DA identified as having been involved in the scheme. Therefore, the AC determined whether the beneficiary was entitled to benefits on or before [Date of Prior Favorable Decision], the date SSA initially allowed the claim(s). By law, SSA was not able to consider the following evidence dated between January 1, 1988 and December 18, 2013: any evidence regarding a mental impairment submitted by one of the four principal facilitators; and medical evidence from two psychiatrists identified by the DA as participating in the alleged scheme, Dr. Edward Sodaro and Dr. Raymond Pierre-Paul;

  • The AC considered all remaining evidence that related to the period on or before the original allowance date; and

  • The AC determined there was sufficient evidence supporting a finding of disability as of [Date of Award Notice].

7. Notification to Program Service Center

The NEPSC is handling all payment matters relating to redeterminations of New York cases. When a redetermined decision is issued, the AC must notify the NEPSC via email at NY ARC PCO DPB NEPC. The AC will use the subject line “OAO redetermination decision-NY” and include the following message in the text of the email:

OAO has issued a redetermination decision for [beneficiary's name (SSN: ###-##-####)]. The favorable decision is [attached/in eView]. Please take any necessary action in this case and notify any other PSC that may be affected by this action. Thank you.

NOTE:

Sending an email to the NEPSC is critical to ensure these decisions are properly and promptly effectuated. For example, if a favorable decision is issued, ARPS will generate an automated alert to the Program Service Center with jurisdiction over the claimant's SSN. The NEPSC must be notified immediately so it can notify the other Program Service Center of the change in jurisdiction.

Send paper folders requiring further action by the NEPSC to:

Social Security Administration
Northeastern Program Service Center
PO Box 319100
Jamaica, NY 11431-9819

8. Representative Fee Issues

For the reasons explained in the NOTE below (i.e., multiple representative situation), the AC must disapprove any newly appointed representative's fee agreement if issuing a favorable decision. See HALLEX I-1-2-12.

Any appointed or previously appointed representative can submit a fee petition for services he or she provided, and the AC will use the applicable procedures in HALLEX I-1-2 for evaluating these requests and determining a reasonable fee. However, if a representative submitted a contingent fee contract, the representative is not entitled to request a fee unless a favorable decision is issued on the redetermination proceedings. See HALLEX I-1-2-51.

NOTE:

Although Mr. Lavallee is now disqualified from serving as a representative before SSA, he could submit a fee petition in a case for services provided before the date of his disqualification. When evaluating any such fee petition, the AC may consider Mr. Lavallee's plea agreement when reviewing the services provided and the results achieved. For authority and additional instruction, see HALLEX I-1-1-57.

Issues relating to any authorized fee to Mr. Lavallee during the original adjudication are outside the scope of this instruction. However, if Mr. Lavallee submits a fee petition when a fee was previously authorized, please refer the issue to the Executive Director's Office for additional instruction.

B. Handling Requests for Review When Case Redetermined at a Prior Administrative Level

When a case subject to this instruction was redetermined at a prior administrative level and, after the usual administrative process, is appealed to the AC (or reviewed on own motion), the AC will evaluate whether the ALJ properly applied the instructions in III.A.

AC staff will establish the case in ARPS and ensure it has the case characteristic “NYIN” (New York Indicted).

Regarding cases that were redetermined at either the reconsideration or ALJ level, the AC will keep in mind that:

  • The ALJ may not dismiss the request for hearing when the case was redetermined at the hearing level.

  • The ALJ can dismiss the request for hearing if the case was redetermined by the field office, was appealed to the hearing level, and the criteria for dismissal are present.

  • If the case was redetermined at another administrative level, the AC can dismiss a request for review if dismissal criteria are present. For dismissal criteria, see HALLEX I-3-4-1.

  • If evidence was disregarded incorrectly at another level (e.g., evidence regarding a physical impairment or evidence dated outside the specified timeframes was erroneously disregarded), the ALJ will address the evidence as outlined in HALLEX I-2-10-10 and I-2-10-14.

  • In a redetermination case, a beneficiary may appeal a determination or decision regarding whether he or she was entitled to benefits on the date he or she was originally allowed, but may not appeal the mandate to redetermine the case or to disregard evidence based on the DA's referral of these cases. However, if the ALJ made an independent fraud or similar fault finding unrelated to and not based on the DA's referral, indictment, or the plea agreements, that finding is appealable.

  • The period at issue in a redetermination case ends with the final and binding decision on the beneficiary's application for benefits (i.e., the original allowance date). Therefore, the ALJ does not generally develop evidence beyond the original allowance date, but may consider other evidence submitted by the beneficiary (or by one of the four principal facilitators or a medical source other than Dr. Sodaro or Dr. Pierre-Paul on his or her behalf) that post-dates the original allowance date if that evidence relates to the period at issue.

  • If the beneficiary submitted evidence to the ALJ with an onset date after the original allowance date, the ALJ will not consider or develop the evidence of the new impairment during the redetermination.

  • In a redetermination case, adjudicators must apply the listings in the Listing of Impairments (20 CFR, Part 404, Subpart P, Appendix 1) that were in effect at the time of the original favorable determination or decision.

  • When handling a request for review when a case was redetermined at a prior administrative level, the AC will follow the national uniformity rules regardless of when the original favorable determination or decision was issued. See 20 CFR 404.970-979 and 416.1470-1479.

If the AC grants review to remand the case, OAO must ensure that the case is routed to the Albany Hearing office. In order to do so, OAO staff will update the hearing office code under “Final Routing Information” to X37 for both Title 2 Routing and Title 16 Routing, as applicable, when closing the case in ARPS.

The AC will additionally send an email to ^OHO R2 Programs with the subject line “AC Remand – NY Redetermination” to alert the Albany Hearing Office of the remand. The content of the email will read as follows:

The Appeals Council has issued a remand on a request for review of a redetermination decision for [beneficiary's or recipient's name (SSN: ###-##-####)]. Please process in accordance with the instructions in HALLEX I-5-6-8. Thank you.

NOTE:

OAO will not close the “NYIN” case characteristic on closure when issuing a remand.

If the AC issues a decision, it will generally follow its usual procedures in HALLEX I-3-8, but will apply the decision writing and effectuation instructions in III.B. above (with appropriate modifications for AC processing). If the AC does not issue a decision, it will use its usual processing requirements when reviewing cases that were redetermined at another administrative level.

V. Inquiries

OHO staff will direct all program-related and technical questions through appropriate management channels.

In OAO, staff and adjudicators will direct any program-related or technical questions to the Executive Director's Office.