I-2-1-33.Allegations of Improperly Completed or Deficient Consultative Examination Reports and Misconduct by Consultative Examination Providers

1. Reporting Allegations of CE Provider Misconduct, Fraud or Similar Fault, or Lack of Qualifications

If a claimant or appointed representative alleges CE provider misconduct, to include allegations of fraud or similar fault, lack of qualifications, or patterns of deficient CEs and reports, OHO staff and adjudicators will report the allegations to OHO management |||OHO OCALJ DFP.

Reports detailing claimant or appointed representative allegations should include the following:

• The claimant's name and Social Security number;

• The name of the CE provider;

• The verbatim allegation(s) (when possible); and

• The exhibit number or location of the allegation in the claim(s) file.

2. Handling Information Related to Another Party Intentionally Submitted to Support Allegations of Patterns of Misconduct or Fraud or Similar Fault

OHO staff must not associate information relating to non-parties with the claimant's record.

If a claimant submits a CE report prepared for an individual who is not a party to the hearing, the adjudicator will acknowledge the allegation and handle the evidence following the procedures in HALLEX I-2-1-24 C.1.

OHO staff and adjudicators will refer allegations relying on evidence involving a non-party to OHO management consistent with the instructions in subsection B.1.

1. CE Report Requirements

Adjudicators must review all CE reports obtained in connection with a claim(s) to ensure the reports comply with the following requirements:

• The CE report must be complete enough to help determine the nature, severity, and duration of the claimant's impairment(s) and the claimant's residual functional capacity (20 CFR 404.1519n(b) and 416.919n(b)).

• A complete CE involves an examination with all the elements of a standard examination in the applicable medical specialty (20 CFR 404.1519n(c) and 416.919n(c)). A complete CE is only necessary when dictated by the particular facts of the case (20 CFR 404.1519n(d) and 416.919n(d)).

• When a complete CE is involved, the report includes the elements identified in the regulations (20 CFR 404.1519n(c) and 416.919n(c)). If the evidence the hearing office (HO) needs does not require a complete CE, the CE report is not required to contain all of the elements identified in the regulations (20 CFR 404.1519n(d) and 416.919n(d)).

• All CE reports must be personally reviewed and signed by the medical source who actually performed the CE (20 CFR 404.1519n(e) and 416.919n(e)). A rubber stamp signature of a medical source or the medical source's signature entered by any other person is not acceptable (20 CFR 404.1519n(e) and 416.919n(e)).

• Adjudicators will not use an unsigned or improperly signed CE report in denials, cessations, or allowances with closed periods of disability or later onsets (20 CFR 404.1519o and 416.919o).

2. Resolving CE Report Deficiencies

If the adjudicator determines the report is inadequate or incomplete due to missing information required to determine the nature, severity, and duration of the claimant's impairment(s), the HO will request that the Disability Determination Service (DDS) resolve the problem by obtaining a properly signed CE report by the original CE provider (HALLEX I-2-5-14 C.3.), having the medical source furnish the missing information by interrogatory, a revised report, or requesting the DDS to arrange for a new CE with a different CE provider (20 CFR 404.1519o, 416.919o, 20 CFR 404.1519p, 416.919p, and HALLEX I-2-5-20 E).

3. Evaluating Allegations that a CE Provider is Unqualified

If a claimant or representative alleges a CE provider is not licensed or has been disqualified, adjudicators must evaluate the allegation on a case-by-case basis, relying on the medical evidence of record, and issue a decision after appropriately weighing the evidence.

OHO staff and adjudicators will report all allegations that a CE provider is unqualified per the instructions in subsection B.1. In addition, the HO will consider whether a referral is appropriate under HALLEX I-2-1-32 B. and C..