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

Last Update: 6/28/22 (Transmittal I-1-103)

If an excluded medical source of evidence (excluded medical source) does not include a written statement of exclusion (see Hearings, Appeals and Litigation Law (HALLEX) manual I-2-5-15 and I-3-2-36) with evidence furnished 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 refer the source to the Office of the Inspector General (OIG) using the Allegation Referral Intake System (ARIS).

NOTE 1:

When referring an excluded medical source to OIG for not providing a written statement of exclusion, Office of Hearings Operations (OHO) staff or the AC will not delay case processing or adjudication unless otherwise instructed by OIG.

NOTE 2:

In addition to the OIG referral, OHO staff and Office of Appellate Operations (OAO) staff must follow additional instructions to complete other required actions when an excluded medical source fails to provide written notice of exclusion. OHO staff will follow instructions in HALLEX I-2-5-15 F and OAO staff will follow instructions in HALLEX I-3-2-36 F.

Examples of instances in which an ALJ or the AC may know or have sufficient reason or information to believe that a source is an excluded medical source and should have included a written statement of exclusion with evidence that was 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; or
The Office of Quality Review identifies the source as an excluded medical source as part of its pre-effectuation review process and informs the ALJ or the AC.

To fill out an ARIS referral for purposes of referring an excluded medical source to OIG, the ALJ, HOD, or the AC will follow the procedures in the ARIS User Guide and within the ARIS application, except as provided in Program Operations Manual System (POMS) DI 23060.040.