Dennis v. SSA, 7:16-cv-00191-GFVT

The SSA Office of the Inspector General investigated suspected fraud by attorney Eric C. Conn, ALJ David Daugherty, and four doctors after detecting unusually high approval rates for Conn’s clients.
The OIG flagged ~1,787 cases; the SSA redetermined benefits for affected claimants and sent letters saying evidence from the suspected providers would be disregarded.
The SSA excluded the named doctors’ medical records entirely in these redeterminations; none of the plaintiffs’ benefits survived the process.
A related group of plaintiffs challenged the redetermination process; the Sixth Circuit in Hicks held the SSA violated the APA and due process by failing to provide an opportunity to rebut the OIG’s off-the-record fraud determinations.
These consolidated actions were stayed pending Hicks; after Hicks, both parties moved for remand—plaintiffs under sentence four of 42 U.S.C. § 405(g), Commissioner under sentence six.
The district court concluded the Sixth Circuit’s ruling required a substantive determination and ordered a sentence-four remand, vacated the redetermination denials, and reinstated benefits pending a proper proceeding.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Proper statutory basis for remand (sentence four vs. six)	Remand under sentence four is appropriate because the court must make a substantive ruling that the redetermination process was unlawful.	Commissioner sought sentence-six remand for further administrative action and possible new evidence.	Court ordered sentence-four remand because Hicks required substantive reversal and restart of the process.
Whether procedural due process was violated	Plaintiffs: SSA denied meaningful opportunity to rebut OIG fraud findings and thus denied due process.	Commissioner: (implicit) process lawful or remand under sentence six could suffice.	Court held procedural due process violated per Hicks; benefits must be reinstated until valid process.
Whether benefits should be reinstated pending remand	Plaintiffs sought reinstatement of benefits during remand.	Commissioner opposed immediate reinstatement absent a valid hearing.	Court reinstated benefits and vacated the redetermination denials until SSA satisfies due-process requirements.
Whether new evidence or posture requires sentence-six remand	Plaintiffs: posture and possibility of new evidence do not change need for sentence-four remand.	Commissioner: sentence-six appropriate for cases involving further administrative action or new evidence.	Court held this is not a sentence-six case; defective process—not new evidence—drives relief, so sentence four required.

Hicks v. Commissioner of Social Security, 909 F.3d 786 (6th Cir. 2018) (court found APA and due-process violations in SSA redetermination process and directed relief)
Melkonyan v. Sullivan, 501 U.S. 89 (U.S. 1991) (distinguishes sentence-four and sentence-six remands under 42 U.S.C. § 405(g))
Jackson v. Chater, 99 F.3d 1086 (11th Cir. 1996) (sentence-four remand appropriate where Commissioner erred by denying full and fair hearing)
Mathews v. Eldridge, 424 U.S. 319 (U.S. 1976) (procedural due process requires meaningful opportunity to be heard)
Faucher v. Secretary of Health & Human Services, 17 F.3d 171 (6th Cir. 1994) (an ALJ may consider new evidence on remand and sentence-four remand terminates district court jurisdiction)
Califano v. Yamasaki, 442 U.S. 682 (U.S. 1979) (court may order interim relief and adjust overpayments where due process defects exist)