The following new final rules will appear in the Federal Register tomorrow:
§ 404.1503b Evidence from excluded medical sources of evidence.
(a) General. We will not consider evidence from the following medical sources excluded under section 223(d)(5)(C) (i) of the Social Security Act (Act), as amended, unless we find good cause under paragraph (b) of this section:
(1) Any medical source that has been convicted of a felony under section 208 or under section 1632 of the Act;
(2) Any medical source that has been excluded from participation in any Federal health care program under section 1128 of the Act; or
(3) Any medical source that has received a final decision imposing a civil monetary penalty or assessment, or both, for submitting false evidence under section 1129 of the Act.
(b) Good cause. We may find good cause to consider evidence from a n excluded medical source of evidence under section 223(d)(5)(C) (i) of the Act, as amended, if:
(1) The evidence from the medical source consists of evidence of treatment that occurred before the date the source was convicted of a felony under section 208 or under section 1632 of the Act;
(2) The evidence from the medical source consists of evidence of treatment that occurred during a period in which the source was not excluded from participation in any Federal health care program under section 1128 of the Act;
(3) The evidence from the medical source consists of evidence of treatment that occurred before the date the source received a final decision imposing a civil monetary penalty or assessment, or both, for submitting false evidence under section 1129 of the Act;
(4) The sole basis for the medical source’s exclusion under section 223(d)(5)(C) (i) of the Act, as amended, is that the source cannot participate in any Federal health care program under section 1128 of the Act, but the Office of Inspector General of the Department of Health and Hum an Services granted a waiver of the section 1128 exclusion; or
(5) The evidence is a laboratory finding about a physical impairment and there is no indication that the finding is unreliable.
3 comments:
This is a complete load of horse ####. Look at section (b)(4). This gives them the ability to continue to use reports from consultative examiners that have been found to submit fraudulent and false reports. "The evidence from the medical source consists of evidence of treatment that occurred before the date the source received a final decision imposing a civil monetary penalty or assessment, or both, for submitting false." This way they don't have to reopen claims denied based on fraudulent evidence.
10:41 - First, that's not (b)(4). Second it applies to evidence of treatment, which i was not under the impression included CEs. Third, this can more easily be interpreted to allow SSA to continue to consider favorable AND unfavorable evidence they believe not tainted by the determination of fraud.
But hey, always start from the assumption that SSA is out to screw everyone. It seems a common hypothesis here.
They should amend SSR 16-3p to state that if treatment evidence is excluded under this rule, then the lack of treating source evidence for the time in question should not be held against the claimant in the symptom analysis.
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