Subject: Fraud, Criminal Violations, and Referrals from OIG
This transmittal amends chapter I-1-3 in the Hearings, Appeals and Litigation Law (HALLEX) manual to incorporate instructions for redeterminations based on fraud or similar fault.
I-1-3-15 A – We added additional information in the NOTE explaining that the information in the section does not apply when adjudicating a redetermination for fraud or similar fault.
I-1-3-15 D – We added a reference to redetermination procedures in HALLEX I-1-3-25.
I-1-3-25 – We added a new section titled “Processing Multiple Cases When Fraud or Similar Fault Involved (“Redeterminations”).”
I-1-3-25 A – We added a subsection titled “Redeterminations — In General” and explain the authority for and when the agency will redetermine a prior favorable allowance.
I-1-3-25 B – We added a subsection titled “Procedures” and include general information about how cases to be redetermined based on fraud or similar fault will be identified, assigned, and processed.
I-1-3-25 C – We added a subsection titled “Special Adjudication Issues in Redeterminations” and explain how the procedures vary from other adjudications involving a fraud or similar fault issue. The issues include notice to a claimant, the period of adjudication, evidence, cessation of benefits, appeals rights, and special decision language.
Date: June 25, 2014