As part of the bipartisan budget of 2015, Congress instructed the Social Security Administration to enact a rule excluding evidence from medical providers who have been convicted of fraud. This mandate arose out of the concern that disability claimants could be gaining an unfair advantage by using medical opinions that had been obtain through dishonest means.
Although this rule serves a good purpose, its strict application could lead to unfair results. In many cases involving fraud accusations, claimants were completely unaware that their lawyers or medical experts were involved in fraud. I have seen this in cases that I have worked on in Kentucky where some claimants were completely unaware of the fraud. Unfortunately, when cases from claimants from Kentucky were re-opened during the course fraud investigations, it was extremely difficult to prove their cases without relying on evidence from sources who were implicated in the scandal. It isn't fair to assume that all medical evidence produced by a doctor who was involved in fraud is unreliable. Take the example of a case from Puerto Rico that I worked on. In Puerto Rico, the same doctor who was involved in the fraud was also hired by the agency to perform consultative evaluations. Under those circumstances, it wasn't fair to exclude the consultative evaluation from the review process.
The proposed regulation will allow the SSA to admit evidence otherwise excluded if there exists "good cause". The proposed regulations lays out five circumstances under which good cause might exist. For a copy of the proposed rule visit:
Another important mandate of this new rule is that it requires medical providers to inform the SSA that they have been subject to penalties for fraudulent conduct.
