HALLEX I-1-3-9 requires an Administrative Law Judge (“ALJ”) to refer a State agency adjudicator suspected of fraud to refer the matter to the Office of Inspector General (“OIG”).
We represent a Social Security Disability (“SSD”) claimant from East Meadow with spine problems. Reports from adjudicators named M. Jackson and M. Censor said the treating physicians were not allowed to do the claimant’s consultative examination (“CE”) because “Prior experience raises a question as to the objectivity, accuracy, or validity of the evidence from the source(s).”
The adjudicators conspicuously failed to identify the actual name of the medical source or sources whose prior experience was questioned. We contacted the claimant’s medical sources about their prior experience with the State agency, and none of them stated that they have had any prior experience with it.
Knowingly making a false boilerplate assertion in order to prevent a treating doctor from performing a CE is fraud. I asked the ALJ to issue a subpoena for the attendance of the adjudicator at the claimant’s hearing for cross-examination. Additionally, I asked the ALJ to notify the OIG about the potential misconduct, especially since was no reason to suspect that it had been limited to this one case.
The ALJ did not make the adjudicator available for cross-examination, and it is unclear if the ALJ referred the matter to the OIG. If anyone waiting for a hearing has a file with similar boilerplate language from an adjudicator, then request that the matter be referred to OIG. Such misconduct should not be overlooked or condoned.
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