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Guidelines -- Appellate Review of Decisions of Administrative Law Judges in Social Security Administration Cases to Which Procedures in 20 C.F.R. Part 498 Apply

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The Code of Federal Regulations (C.F.R.) Part 498 of Title 20 and Sections 1129 and 1140 of the Social Security Act authorize the Social Security Administration’s Inspector General (I.G.) to impose civil money penalties and assessments on individuals or entities, based on certain determinations. An individual or entity affected by such a determination is entitled to a hearing before an Administrative Law Judge (ALJ) under the procedures at 20 C.F.R. Part 498. See 20 C.F.R. § 498.202(a). A dissatisfied party may request review of the ALJ decision by the Departmental Appeals Board (Board) in accordance with the procedures in 20 C.F.R. § 498.221. These guidelines have been designed to assist the parties in understanding and following the procedures relating to Board review.

If you have any questions about these guidelines, you may call Appellate Division attorney Carolyn Reines-Graubard at (202) 565-0116.

Starting the Review Process
(a) Under 20 C.F.R. § 498.221(a), either party dissatisfied with the ALJ decision may appeal that decision to the Board by filing a notice of appeal with the Board within the specified time period.

(b) An affected individual or entity has a right to be represented before the Board, at the individual's or entity's own expense, by an attorney or someone else. A representative should file with the Board a signed statement that he or she has been authorized to represent the affected individual or entity, unless the same representative appeared in the proceedings before the ALJ.

(c) Your notice of appeal must be filed within 30 days of the date of service of the ALJ decision unless you file a written request for an extension which the Board grants for good cause shown. Your request for an extension must be filed within the initial 30-day period and should explain why there is good cause for the requested extension, which may not exceed 30 days. If the ALJ decision is mailed to you, the date of service is deemed to be five days from the date of mailing.

(d) Your notice of appeal must be accompanied by a written brief specifying each finding of fact and conclusion of law with which you disagree, and your basis for contending that each such finding or conclusion is unsupported or incorrect. The Board expects that the basis for each challenge to a finding or conclusion in the ALJ decision will be set forth in a separate paragraph or section, and that the accompanying arguments will be concisely stated. In addition, where appropriate, each argument should be supported by precise citations to the record and/or by precise citations to statutes, regulations or other relevant authorities upon which you are relying.

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Filing Requirements for All Submissions
(a) A submission is considered "filed" with the Board on the postmark date, the date sent by registered or certified mail, the date deposited with a commercial delivery service, or the date a fax (where permitted) is sent.

(b) If the last day of the period for filing a submission falls on a federal nonworkday (a Saturday, Sunday, legal holiday, or a day which by statute or Executive Order is declared to be a nonworkday for federal employees), the submission may be filed on the next federal workday.

(c) All submissions to the Board should be addressed to:

Department of Health and Human Services
Departmental Appeals Board, MS 6127
Appellate Division
330 Independence Ave., S.W.
Cohen Building, Room G-644
Washington, D.C. 20201

Faxes should be sent to (202) 565-0238. Please do not fax a submission if it is over 10 pages.

(d) Both parties should provide an original and two copies of all submissions to the Board and a copy to the opposing party. (If your submission is faxed, the required two copies should be mailed.) Include in any submission to the Board a statement that you have sent a copy to the opposing party.

(e) The parties should not submit to the Board materials already submitted to the ALJ since those materials will be transferred to the Board by the ALJ.

(f) A submission (including the notice of appeal) may not incorporate by reference a brief or parts of a brief previously submitted to the ALJ.

(g) Certain written submissions are subject to page limits, unless the Board grants a motion to increase the number of pages: brief accompanying notice of appeal - no more than 40 pages; response - no more than 40 pages; reply - no more than 20 pages. If typed, the submission should be double-spaced and the font size should be no less than 12. Cover letters and attachments are not included in the page count.

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Development of the Record on Appeal
(a) The notice of appeal is referred to a panel of three Board members, one of whom presides over the development of the record on appeal. The Presiding Board Member is assisted by a staff attorney whom the parties may contact if they have questions about case status or procedures.

(b) The opponent of the party that filed the notice of appeal may submit a response, which may also raise any relevant issue not addressed in the notice of appeal. The response must be filed within 30 days after the opposing party receives a copy of the notice of appeal.

(c) The party that filed the notice of appeal may request permission from the Board to file a reply brief.

(d) The Board expects a party needing an extension for filing a response (or any other submission permitted or required by the Board) to file a request for an extension before the original due date, to include a statement about whether the opposing party objects to the requested extension, and to state the reasons for the request. The Board will grant an extension only for good cause shown.

(e) On rare occasions, the Board may grant a request for oral argument if the Board determines that oral argument would facilitate its decisionmaking. A party wishing to appear before the Board to present oral argument should request such an opportunity in the notice of appeal or the response and should state the purpose of the requested appearance. Generally, any oral proceeding will be conducted by the Presiding Board Member by telephone conference rather than in person.

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Completion of the Review Process
(a) The Board will review only those parts of the record before the ALJ which are cited by the parties or which the Board considers necessary to decide the appeal. The Board will not consider issues not raised in the notice of appeal or in the opposing party's response, nor issues which could have been presented to the ALJ but were not. See 20 C.F.R. § 498.221(f).

(b) If a party demonstrates to the satisfaction of the Board that evidence not presented to the ALJ is relevant and material and that there were reasonable grounds for the failure to present the evidence to the ALJ, the Board may remand the case to the ALJ for consideration of such additional evidence.

(c) The standard of review on a disputed factual issue is whether the ALJ's initial decision is supported by substantial evidence on the whole record. The standard of review on a disputed issue of law is whether the ALJ's initial decision is erroneous. See 20 C.F.R. § 498.221(i).

(d) The Board may either remand a case to the ALJ for further proceedings, issue a recommended decision to decline review of the case, or issue a recommended decision to affirm, increase, reduce, or reverse any penalty or assessment determined by the ALJ.

(e) The Board will complete its review and issue any recommended decision, along with the complete record upon which the recommended decision is based, to the Commissioner of Social Security (Commissioner) within 60 days after the time for the last submission permitted by the Board has expired. The Board will send a copy of the recommended decision to both parties.

(f) The Commissioner may reverse or modify the Board's recommended decision within 60 days after the date of service of the recommended decision on the Commissioner and the parties. If the Commissioner reverses or modifies the recommended decision, the Commissioner's decision is final and binding on both parties. If the Commissioner does not reverse or modify the Board's recommended decision, the recommended decision becomes the final decision of the Commissioner.

(g) The Board will serve a copy of the final decision of the Commissioner on both parties after the Commissioner notifies the Board whether or not he has reversed or modified the Board's recommended decision.

(h) An affected individual or entity that is dissatisfied with the final decision of the Commissioner may obtain judicial review of the decision by filing a petition for judicial review in the appropriate United States Court of Appeals within 60 days after the parties are served with a copy of the final decision. If the decision is mailed, the date of service will be deemed to be five days from the date of mailing. If a petition for judicial review is filed, a copy of the filed petition must be sent by certified mail, return receipt requested, to the Social Security Administration's General Counsel.

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Last Revised: December 1, 2008