Background

This transmittal amends Hearings, Appeals and Litigation Law (HALLEX) manual sections I-5-6-7 and I-5-6-7A to update instructions relating to a referral under section 1129(l) of the Social Security Act from the Office of the Inspector General (OIG) of the Social Security Administration (SSA).

Explanation of Content and Changes

HALLEX I-5-6-7 – In section II, we added information that OIG notified SSA through a supplemental section 1129(l) referral dated May 19, 2017 that it had reason to believe fraud was involved in the application of additional individuals seen by psychiatrist Fernando Mendez-Villamil, M.D. We added the supplemental referral to Attachment 1 and updated processing instructions to note the applicable referral should be added to the claim(s) file when processing a redetermination. We additionally updated the Hearing Office Notice in Attachment 5 and Appeals Council Notices in Attachment 6.

HALLEX I-5-6-7A – In section II, we added information that OIG notified SSA through a supplemental section 1129(l) referral dated May 19, 2017 that it had reason to believe fraud was involved in the application of additional individuals seen by psychiatrist Fernando Mendez-Villamil, M.D. We added the supplemental referral to Attachment 1 and updated processing instructions to note the applicable referral should be added to the claim(s) file when processing the pending case.

Date: July 17, 2017