For definitions of fraud and similar fault in regard to evidence in a claim(s), see Hearings, Appeals, and Litigation Law (HALLEX) manual HA 01130.015 B.

For definitions associated with administrative sanction cases, see HALLEX HA 01295.016.

For general information relating to redeterminations based on fraud or similar fault, see HALLEX HA 01130.025.

For general information relating to “non-redetermination cases” based on fraud or similar fault, see HALLEX HA 01130.026.

For information on evaluating allegations of fraud or similar fault submitted by the claimant or representative, see HALLEX HA 01295.012.

When a case involves an issue of fraud or similar fault, the ALJ may be responsible for determining one or more of the following:

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  Whether certain evidence must be disregarded (HALLEX HA 01295.010);

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  Whether to impose administrative sanctions in the form of nonpayment of benefits (HALLEX HA 01295.016); and

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  Whether a prior final determination or decision should be reopened under the rules of administrative finality because it was obtained by fraud or similar fault (HALLEX HA 01290.065).

Due to possible litigation concerns, and to avoid the appearance of impropriety, ALJs will not attempt to contact or question an Office of the Inspector General (OIG) agent or witness unless HALLEX HA 01295.008 A. applies.

However, there is no prohibition on ALJs consulting with other appropriate non-OIG personnel about technical issues or questions of law or policy regarding information from OIG (through the appropriate management chain). Additionally, this instruction does not preclude a person or party from inquiring about the status of a case or asking routine questions about administrative functions or procedures.