Public Health Law Map - Beta 5 - Medical and Public Health Law Site

c) The Goldberg Rights
Persons whose rights are at issue in an administrative proceeding do have due
process protections, depending on the rights at issue. The leading case involved
welfare beneficiaries whose benefits under the Aid to Families with Dependent
Children program were terminated. The U.S. Supreme Court held that they were
entitled to a hearing and certain due process rights:
1. the right to present an oral case
2. the right to confront witnesses
3. the right to be represented by an attorney, although the court did not create a
right to appointed counsel
4. the right to have the decision based on the record before the ALJ
These are known as the Goldberg rights, after the case that established them.
[Goldberg v. Kelly, 397 U.S. 254 (1970)] The availability of the Goldberg rights
depends on the nature of the private interest that is threatened, the probability of an
erroneous decision, the potential value of the evidence, and the cost to the
government. These are important to medical care practitioners in proceedings such
as license revocation hearings and other proceedings where the practitioner’s
livelihood is at issue.
d) The ALJ’s Decision
The ALJ questions witnesses, the agency staff, and the outside parties. The ALJ
role is to ensure that a full and balanced record is developed to aid in making his or
her decision, and for the agency to use in the review of the ALJ’s decision. When
the proceeding is completed, the ALJ makes a decision and that becomes part of
the record. Unlike the decision of a judge in a court proceeding, the ALJ’s decision
is not final. It is legally only a recommendation to the agency director as to the best
way to proceed. In most cases the agency will adopt the ALJ’s recommendation,
but it is not bound to. In federal agencies, the head of the agency is free to come to
a different conclusion, based on the record, and to make a final agency rule that is
different from that of the ALJ. In some circumstances the agency provides an
internal appeal procedure for ALJ determinations. In some states the administrative
hearing process is done outside of the agency and the ALJ’s decision is final. There
are procedures for appealing agency decisions in the courts.
e) Informal Agency Action
The vast majority of agency actions are done informally. For example, every claim
for payment for medical treatment rendered to a Medicare patient requires agency
action. There must be a determination that the care was rendered by a provider
entitled to payment, that the care was necessary and proper, and the amount that
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