## Facts

- The Social Security Administration (SSA) identified a large set of disability beneficiaries whose favorable decisions were connected to attorney Eric C. Conn’s fraud scheme involving paid medical reports and an Administrative Law Judge.
- After an Office of the Inspector General referral asserting “reason to believe” fraud, SSA began statutory redeterminations of eligibility under 42 U.S.C. §§ 405(u) and 1383(e)(7).
- In those redeterminations, SSA and its ALJs categorically excluded all medical evidence from certain sources associated with the scheme, without allowing individualized challenges to whether specific records were reliable.
- Many claimants lost benefits and were assessed overpayments, even though they were not accused of participating in fraud and, in some cases, the excluded records were the only evidence supporting disability.
- Claimants sued, alleging that SSA’s blanket exclusion policy violated the statutes and denied procedural due process; the district court largely upheld SSA’s approach.
- Consolidated appeals were taken to the Sixth Circuit.

## Issues

1. Whether 42 U.S.C. §§ 405(u) and 1383(e)(7) permit SSA to categorically disregard all evidence from sources implicated in a broader fraud scheme, without item-specific findings.
2. Whether automatically excluding all Conn-related medical evidence without allowing claimants to rebut the presumed taint violates the Fifth Amendment’s procedural due process requirements.

## Decision

- The Sixth Circuit vacated and remanded.
- The court held the statutes require SSA to disregard evidence only when there is reason to believe fraud or similar fault was involved in providing the particular evidence at issue, not all evidence from a source.
- The court held SSA’s non-rebuttable, categorical exclusion procedure violated procedural due process by denying claimants a meaningful opportunity to contest the agency’s basis for disregarding evidence.
- On remand, SSA had to provide proceedings in which it identifies suspect evidence and allows claimants to respond and offer proof that specific items should not be disregarded.

## Legal Principles

- Under 42 U.S.C. §§ 405(u) and 1383(e)(7), “reason to believe” and “such evidence” require an item-specific inquiry; source-based blanket exclusion is inconsistent with the statutory text.
- Procedural due process applies to disability benefit terminations and redeterminations and requires a meaningful opportunity to be heard at a meaningful time.
- When the government presumes evidence is tainted and the presumption is outcome-determinative, due process generally requires an opportunity to rebut the presumption and contest the exclusion, especially where claimants are not accused of wrongdoing.
- Administrative efficiency and antifraud interests do not justify procedures that create a high risk of erroneous deprivation when additional safeguards are feasible.

## Conclusion

The Sixth Circuit required SSA, in fraud-based disability redeterminations, to assess whether specific evidence is tainted rather than excluding entire categories of evidence based on source affiliation, and to provide claimants a meaningful chance to challenge the agency’s fraud-taint determination before benefits are terminated or overpayments imposed.


Hicks v. Comm’r of Soc. Sec., 909 F.3d 786 (6th Cir. 2018)