Effective Dates: 12/13/2022 - Present Previous | Next

TN 6 (12-22)

DI 23060.020 Identifying Excluded Medical Sources of Evidence

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§ 812; 20 CFR §§ 404.1503b, 416.903b

A. Excluded medical sources of evidence must provide a written statement of exclusion

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, or other individual or entity.

Adjudicators have no duty to identify excluded medical sources of evidence on their own. However, if there is no written statement of exclusion, and an adjudicator receives clear documentation that a source is an excluded medical source of evidence, the adjudicator must exclude the source’s evidence (unless there is sufficient information to apply a good cause exception(s)).

Additionally, if there is no written statement of exclusion, and an adjudicator receives clear documentation that a source is an excluded medical source of evidence, the adjudicator should refer the source to the Social Security Administration’s Office of the Inspector General (SSA’s OIG). See DI 23060.040 for how to refer an excluded medical source of evidence to SSA’s OIG.

An example of clear documentation is an email from an administrator or professional relations officer to all staff stating that John Doe, M.D., is an excluded medical source of evidence because he was convicted of a felony under section 208 of the Social Security Act (Act) on November 2, 2016.

Another example of clear documentation that a source is an excluded medical source of evidence is a flagged medical source in the Disability Case Processing System (DCPS) vendor repository. After the excluded source's status has been verified by SSA personnel, the medical source would be flagged with an "Excluded Source" badge in DCPS.

B. Contents and placement of the written statement of exclusion

1. Contents of the written statement of exclusion

All written statements of exclusion must include the following:

  1. a. 

    The heading, “WRITTEN STATEMENT REGARDING SECTION 223(d)(5)(C) OF THE SOCIAL SECURITY ACT – DO NOT REMOVE;”

  2. b. 

    The name and title of the excluded medical source of evidence; and

  3. c. 

    The reason we cannot consider the evidence furnished by the excluded medical source of evidence – i.e., that the medical source was:

    • •

      Convicted of a felony under section 208 or 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.

As applicable, all written statements of exclusion must also include:

  • •

    The date of the felony conviction under section 208 or 1632 of the Act;

  • •

    The reason, effective date, and expected length of exclusion under section 1128 of the Act, and whether the Office of Inspector General of the Department of Health and Human Services (HHS’ OIG) has waived the exclusion; and

  • •

    The date of the CMP, assessment, or both, for submitting false evidence under section 1129 of the Act.

2. Placement of the written statement of exclusion

Excluded medical sources of evidence should place the written statement of exclusion after the barcode page, but before the first page of evidence.

If a written statement of exclusion is placed somewhere else in the evidence, adjudicators do not have to move it.

C. Unclear or incomplete written statements of exclusion

If a written statement of exclusion does not include information that allows an adjudicator to determine whether a good cause exception(s) may apply, the adjudicator should contact the excluded medical source of evidence for clarification or additional information. See DI 22505.008 for instructions on developing supplemental evidence.

D. Annotating case folders

1. Certified electronic folders

For electronic cases:

  • •

    Add flag number 42, “Excluded Medical Source of Evidence”

  • •

    Change the document type of the affected evidence to document type number 0028, “Excluded Medical Source of Evidence.”

    See DI 81020.040 for more information on document types.

2. Paper case folders

For paper cases:

  • •

    Print out the “Excluded Medical Source of Evidence” flag,

  • •

    Fill in the requested information,

  • •

    Identify the evidence furnished by the excluded medical source of evidence and explain the evaluation of it in the Remarks section, and

  • •

    Attach the completed flag to the front of the paper case folder.

E. Refer questions about excluded medical sources of evidence to SSA’s public website or national 800 number network

SSA cannot answer questions about why, how, or when a medical source was:

  • •

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

  • •

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

  • •

    Imposed with a CMP, assessment, or both, for submitting false evidence under section 1129 of the Act.

Refer all such questions to our public webpage (www.socialsecurity.gov/applyfordisability) and the link, “Information on Excluding Certain Medical y at 1-800-772-1213 (TTY 1-800-325-0778).

F. Notice for Excluded Medical Sources of Evidence Who Do Not Comply with Reporting Requirements

When an SSA excluded medical source of evidence furnishes evidence to us but does not also provide the required written statement of exclusion, we will mail a notice to the medical source.

Depending on the adjudicative level of the claim, the Office of Disability Determinations, the Office of Hearings Operations, or the Office of Appellate Operations is responsible for mailing this notice. The component responsible for mailing the notice must:

If a medical provider identified as an excluded source of medical evidence continues to submit evidence without self-identifying, please refer the excluded provider by completing a referral through the Allegation Referral Intake System (ARIS). See DI 23060.040 for instruction on referring non-compliant excluded medical sources of evidence to the Social Security Administration’s Office of the Inspector General.

G. Notice for Excluded Medical Sources of Evidence

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To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423060020
DI 23060.020 - Identifying Excluded Medical Sources of Evidence - 12/13/2022
Batch run: 12/13/2022
Rev:12/13/2022