Effective Dates: 12/16/2021 - Present Previous | Next

TN 4 (12-21)

DI 23060.040 Referring Non-Compliant Excluded Medical Sources of Evidence to the Social Security Administration’s Office of the Inspector General (SSA’s OIG)

CITATIONS:

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

A. Referring excluded medical sources of evidence to SSA’s OIG

1. When to refer

Excluded medical sources of evidence must provide a written statement of exclusion each time they furnish evidence to us directly or indirectly through a representative, claimant, individual or other entity, see DI 23060.020A. If an excluded medical source(s) of evidence does not include a written statement of exclusion with the furnished evidence, refer the source to SSA's OIG. For more information about excluded medical sources of evidence, see DI 23060.010.

EXAMPLE: An excluded medical source of evidence submits evidence without including a written statement of exclusion. The adjudicator receives clear documentation (e.g., an email from a DDS administrator or professional relations officer) that the source is an excluded medical source of evidence. Refer the source to SSA’s OIG.

2. How to refer

Follow these two steps when referring an excluded medical source(s) of evidence to SSA's OIG.

1. Use the Allegation Referral Intake System (ARIS).

2. Send an email containing the excluded source's name and date of violation to ^ODP BBA 812.

B. The referral does not delay case development or adjudication

Referring an excluded medical source of evidence to SSA’s OIG for not providing a written statement of exclusion does not delay case development or adjudication. Unless otherwise instructed by SSA’s OIG, continue to develop and adjudicate the case using normal procedures.

NOTE: Do not consider evidence furnished by an excluded medical source of evidence referred to SSA’s OIG unless there is sufficient information in the folder to apply a good cause exception(s).

For more information see DI 23060.010B.3.

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423060040
DI 23060.040 - Referring Non-Compliant Excluded Medical Sources of Evidence to the Social Security Administration’s Office of the Inspector General (SSA’s OIG) - 12/16/2021
Batch run: 04/05/2024
Rev:12/16/2021