Occasionally, HO personnel may discover potential issues regarding
the conduct, qualifications, or performance of an ME, VE, or consultative
examiner during case adjudication.
When a referral for further consideration
of an ME or VE may be warranted, the person who
discovers the issue will complete a Report
of Non-Conformance and forward it to an HO manager. When a referral
for further consideration of a consultative examiner may be warranted,
the person who discovers the issue will notify an HO manager. In both
situations, the manager will discuss the issue with the ALJ assigned to
the case. If the case has not yet been assigned to an ALJ, the manager
will discuss the issue with the Hearing Office Chief Administrative Law
Judge (HOCALJ).
If the ALJ or HOCALJ agrees that a referral of an ME or VE is
appropriate, the ALJ or HOCALJ will direct the manager to send an
email to the RO Contracting Officer's Representative (COR) with the
subject line “Possible Expert Misconduct Referral.”
The manager will include the complete Report
of Non-Conformance. However, while the matter is under review,
the ME or VE is permitted to provide testimony.
If the ALJ or HOCALJ agrees a referral of a consultative
examiner is appropriate, the ALJ or HOCALJ will direct the HO manager
to notify the appropriate regional DDS CEC and email the RO contact
with the subject line “Possible Consultative Examiner Misconduct
Referral.”
The content of the email will include the following
information:
•
The claimant's name and Social Security
number;
•
The name of the ME, VE, or consultative
examiner;
•
A brief description of the conduct or possible
qualification issue; and
•
The exhibit number or location of the relevant information
in the file.
If the case is paper, the appropriate
HO personnel will transmit copies of any relevant documents to the DDS
and RO via email, fax, or regular mail.
After sending the email, the person making the referral
will add the expert conduct case characteristic “EXCN” in the applicable case processing
system(s).
If HO personnel suspect fraudulent
behavior, they need not consult with a manager before referring the matter
to the Office of the Inspector General (OIG), as explained in HALLEX
HA 01130.009.