Effective Dates: 11/18/2016 - Present Previous | Next

Basic (10-16)

DI 23060.010 Excluded Medical Sources of Evidence – Introduction and Definitions

CITATIONS:

Soc. Sec. Act as amended in 2015, Secs. 223(d)(5)(C), 1614(a)(3)(H)(i), 42 U.S.C. §§ 423(d)(5)(C), 1382c(a)(3)(H)(i);
P.L. 114-74, § 812; 20 CFR §§ 404.1503b, 416.903b

A. Introduction to excluded medical sources of evidence

Absent good cause, exclude evidence from medical sources identified in section 223(d)(5)(C) of the Social Security Act (Act), as amended by section 812 of the Bipartisan Budget Act of 2015 (BBA 812). We refer to such medical sources as excluded medical sources of evidence.

NOTE: This subchapter applies only to excluded medical sources of evidence. It does not apply to representatives and health care providers excluded from participating in Social Security’s programs under section 1136 of the Act.

B. Definitions related to excluded medical sources of evidence

1. Excluded medical sources of evidence

Are medical sources:

  • •

    Convicted of a felony under section 208 or section 1632 of the Act;

  • •

    Excluded from participating in any Federal health care program under section 1128 of the Act; or

  • •

    Imposed with a civil monetary penalty (CMP), assessment, or both, for submitting false evidence under section 1129 of the Act.

2. Furnish evidence

To submit, provide, or supply evidence.

NOTE: Excluded medical sources of evidence may furnish evidence that they generated, created, or otherwise have within their possession.

NOTE: Excluded medical sources of evidence may furnish evidence to us directly or indirectly through a claimant representative, or other individual or entity.

3. Good cause exceptions

Permit consideration of evidence furnished by an excluded medical source of evidence. See DI 23060.030B for a list of the five good cause exceptions.

4. Written statement of exclusion

A written statement submitted by a medical source that informs us that the source is an excluded medical source of evidence. See DI 23060.020 for when, where, and what information an excluded medical source of evidence should include in the written statement of exclusion.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423060010
DI 23060.010 - Excluded Medical Sources of Evidence – Introduction and Definitions - 11/18/2016
Batch run: 01/15/2019
Rev:11/18/2016