For definitions of fraud and similar fault, see Hearings, Appeals, and Litigation Law (HALLEX) manual HA 01130.015 B.

For definitions and instructions associated with administrative sanction cases, see HALLEX HA 01295.016 and HA 01395.011.

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 01395.012.

When a case involves an issue of fraud or similar fault, or in an administrative sanction action, the AC will consider issues such as the following:

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  Whether the notice and hearing decision requirements were followed (see HALLEX HA 01295.006, HA 01295.012, and HA 01295.014);

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  Whether certain evidence was properly disregarded (see HALLEX HA 01295.010);

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  Whether the appropriate administrative sanctions were imposed (see HALLEX HA 01295.016); and

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  Whether reopening issues were handled in accordance with agency policy (see HALLEX HA 01290.065).

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  Whether a case referred under 205(u) and 1631(e)(7) of the Social Security Act was processed in accordance with agency policy (see HALLEX HA 01130.025 and HA 01130.026).

Due to possible litigation concerns, and to avoid the appearance of impropriety, the AC will not attempt to contact or question an OIG agent or witness.

However, there is no prohibition on the AC 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.