Departmental Appeals Board At Social Security? OIG A Party Appealing ALJ Decisions?
Can someone explain to me the process discussed in the Second Circuit decision in Capetta v. Commissioner of Social Security? Was the Court just confused in its description of the administrative process?
If this is what SSA considers "fraud," no wonder idiots think there is "fraud" in disability. Even under surveillance, they only saw him running an errand. I would describe what was going on as closer to "charity" than "employment." So, does this mean if your mom says, "I'll give you $20 for gas if you pick me up a pizza," that you need to report that to SSA? Seriously? An ALJ ruled twice against any penalty!
Well just off the top of my head, it looks like this started out as an over payment/fraud case at some point after DIB was already awarded. It is not unusual for OIG to get involved in the over payment cases involving fraud.
As for the DAB reference, I am not really sure but I wonder if the case was processed during the time that we had that alternate process DSI, i think it was called and there was some kind of appeals body other than the AC. Not sure, just thinking out loud.
When OIG imposes civil monetary penalties, the claimant can appeal that imposition to an ALJ at the Departmental Appeals Board (DAB) of HHS through an inter-agency agreement. The ALJ referenced in this decision would not have been an SSA ALJ, but an HHS ALJ. I am not familiar with the appeals beyond that level, but it sounds like there is a secondary level of appeal available via the DAB, which would then be followed by an appeal to the Court of Appeals.
"the DAB...is part of DHHS, not the SSA... the Commissioner tasked the DAB with providing ALJ administrative hearings and then reviewing the resulting decisions for cases involving an assessment and penalty under 42 U.S.C. § 5 1320a‐8. See 20 C.F.R. §§ 498.201498.202, 498.221. After the DAB’s process is complete, its final decision becomes the Commissioner’s decision unless the DAB remands the decision to the ALJ. Id. § 8 498.222(a)."
The confusing part is that if "the commissioner tasked the DAB with providing ALJ administrative hearings", then why is SSA conducting the hearings? The other really weird part is that appeals from this process goes straight to the Court of Appeals instead of the District Court, according to the decision.
Actually it was originally filed in the Connecticut Fed District Court, (3:16-cv-00763-RNC Cappetta v. Commissioner of Social Security), but once the government filed a Motion to Dismiss for Lack of Jurisdiction,(no appeal of a "final decision" under 42 U.S.C. Section 405(g)), the Respondent filed an unopposed Motion to Transfer to the USCA for the 2d Cir.
If this is what SSA considers "fraud," no wonder idiots think there is "fraud" in disability. Even under surveillance, they only saw him running an errand. I would describe what was going on as closer to "charity" than "employment." So, does this mean if your mom says, "I'll give you $20 for gas if you pick me up a pizza," that you need to report that to SSA? Seriously? An ALJ ruled twice against any penalty!
ReplyDeleteWell just off the top of my head, it looks like this started out as an over payment/fraud case at some point after DIB was already awarded. It is not unusual for OIG to get involved in the over payment cases involving fraud.
ReplyDeleteAs for the DAB reference, I am not really sure but I wonder if the case was processed during the time that we had that alternate process DSI, i think it was called and there was some kind of appeals body other than the AC. Not sure, just thinking out loud.
When OIG imposes civil monetary penalties, the claimant can appeal that imposition to an ALJ at the Departmental Appeals Board (DAB) of HHS through an inter-agency agreement. The ALJ referenced in this decision would not have been an SSA ALJ, but an HHS ALJ. I am not familiar with the appeals beyond that level, but it sounds like there is a secondary level of appeal available via the DAB, which would then be followed by an appeal to the Court of Appeals.
ReplyDeleteThe DAB is part of HHS. SSA has a reimbursable agreement with the DAB to adjudicate civil monetary penalty determinations by SSA.
ReplyDeletehttps://www.hhs.gov/about/agencies/dab/different-appeals-at-dab/appeals-to-alj/index.html
https://www.hhs.gov/sites/default/files/static/dab/decisions/board-decisions/2016/a-15-105.pdf
https://oig.ssa.gov/sites/default/files/semiannual/Spring%202018%20SARC%20-%20FINAL%20VERSION.pdf#page=38
https://www.ecfr.gov/cgi-bin/text-idx?SID=372e5dcc814b83095bdc9fbcae083506&mc=true&node=pt20.2.498&rgn=div5#se20.2.498_1201
https://www.gpo.gov/fdsys/pkg/FR-1996-12-13/pdf/96-31536.pdf
The decision explains that:
ReplyDelete"the DAB...is part of DHHS, not the SSA... the Commissioner tasked the DAB with providing
ALJ administrative hearings and then reviewing the resulting decisions
for cases involving an assessment and penalty under 42 U.S.C. § 5
1320a‐8. See 20 C.F.R. §§ 498.201498.202, 498.221. After the DAB’s
process is complete, its final decision becomes the Commissioner’s
decision unless the DAB remands the decision to the ALJ. Id. § 8
498.222(a)."
The confusing part is that if "the commissioner tasked the DAB with providing ALJ administrative hearings", then why is SSA conducting the hearings? The other really weird part is that appeals from this process goes straight to the Court of Appeals instead of the District Court, according to the decision.
Obviously, the court is confusing the HHS DAB which hears Medicare appeals with SSA's Appeals Council! Someone writing the opinion goofed!
ReplyDeleteActually it was originally filed in the Connecticut Fed District Court, (3:16-cv-00763-RNC Cappetta v. Commissioner of Social Security), but once the government filed a Motion to Dismiss for Lack of Jurisdiction,(no appeal of a "final decision" under 42 U.S.C. Section 405(g)), the Respondent filed an unopposed Motion to Transfer to the USCA for the 2d Cir.
ReplyDeletehttps://www.pacermonitor.com/public/case/11500578/Cappetta_v_Commissioner_of_Social_Security