20 CFR 404.1503b(c) & 416.903b(c)

Notice Clearance Package:
DOCUMENT PROCESSING SYSTEM
NOTICE OF BBA 812 MEDICAL PROVIDER
NON-COMPLIANCE
Language Creation
OMB Number: 0960-0803
1/24/2018

BACKGROUND

The Office of Disability Policy created a notice to notify medical providers that they have failed
to comply with the Bipartisan Budget Action (BBA) Section 812. Medical providers must selfidentify as violators of BBA 812 if they have been identified by the Department of Health and
Human Services (HHS) List of Excluded Individual Entities (LEIE) excluding their participation
in Federal health care programs, convicted of a felony, and/or imposed a civil monetary penalty.
Please provide your comments and concurrence/non-concurrence on this notice clearance
package. If you have any questions, please contact Zachary Hearn (x5-6601).

XXXX BBA Section 812 Letter
XXXX Exhibit The BBA 812 letter was created to fulfill the requirements outlined in Section
812 of the 2015 BBA. SSA’s regulations, found at 20 C.F.R. §§ 404.1503b, 416.903b, require
medical providers to notify SSA when presenting evidence if they have been (1) convicted of a
felony under section 208 or 1632 of the Social Security Act (Act); (2) excluded from
participating in any Federal health care program under section 1128 of the Act; or (3) imposed
with a civil monetary penalty (CMP), an assessment, or both, for submitting false evidence under
section 1129(l) of the Act. Medical providers who do not comply with the statutory reporting
requirements are notified through this letter.
Current reading grade level: 11.4
Volume: This is a new document; no historical data is available.
Notice system:
POMS Reference:
DI 23060.020: Identifying Excluded Medical Sources of Evidence

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BBA 812 VIOLATOR NOTIFICATION LETTER

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Sample BBA 812 Notice

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Social Security Administration
Important Information
[SSA Component]
[Address Line 1]
[Address Line 2]
[Date]
[Excluded Entity Name/Title]
[Address Line 1]
[Address Line 2]
We are writing to you because we have reason to believe you are a medical source excluded
under section 223(d)(5)(C) of the Social Security Act (Act). You are not following the rules for
submitting evidence to us as an excluded source. If you do not comply with our regulations
when submitting evidence to us, we may refer you to our Office of Inspector General (OIG) for
potential further action. This action may include an investigation and civil monetary penalties
(CMP).
The Regulations You Are Not Following
Our regulations, 20 C.F.R. 404.1503b and 416.903b, impose specific reporting requirements on
medical sources who were:


convicted of a felony under section 208 or 1632 of the Act,



excluded from participating in any Federal health care program under section 1128 of the
Act, or



imposed with a CMP, assessment, or both, for submitting false evidence under section
1129 of the Act.

The information we received from the Secretary of the Department of Health & Human Services
or our OIG indicates you are one of these medical sources. Our records further indicate you are
not complying with the specific reporting requirements that pertain to you as set forth in our
regulations. As an excluded medical provider, you are required to provide a written statement of
exclusion. The statement must include the following:



Name and title of the excluded medical source of evidence, and
Basis for the exclusion.

As applicable, the statement must also include:




The date of the felony conviction under section 208 or section 1632 of the Act,
The reason, effective date, and expected length of the exclusion under section 1128 of the
Act, and whether the exclusion was waived by the Office of Inspector General of the
Department of Health and Human Services, and
The date of the final decision imposing the CMP, assessment, or both, for submitting
false evidence under section 1129 of the Act.

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We Previously Advised You of These Regulations
We previously sent you Social Security Administration (SSA) Publication No. 64-106,
“Exclusion of Certain Medical Sources’ Evidence,” at the address provided to us by either the
Secretary of the Department of Health and Human Services or our OIG. This publication
explains our regulations and the specific reporting requirements you must follow. Enclosed
please find another copy of this publication. We encourage you to read it carefully.
You may also visit our website at https://www.ssa.gov/applyfordisability/medical_sources.html
for additional information, including model documents that you may use to satisfy your specific
reporting requirements.

If You Have Questions
If you have questions, you may call us toll-free at 1-800-772-1213. If you are deaf or hard of
hearing, you may call our TTY number, 1-800-325-0778. We can answer most questions over
the phone. You can also write or visit any Social Security office. The office that serves your
area is located:
Social Security Office
Street address
City, State Zip
If you call or visit an office, please have this letter with you. It will help us answer your
questions. If you plan to visit an office, you may call ahead to make an appointment. This will
help us serve you more quickly when you arrive at the office.

Social Security Administration
Enclosure

[Paperwork Reduction Act Language]
[Privacy Act Language]

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