ALJ Hearing?

5 Things Doctors & Medical Professionals Need to Know

As a doctor, your medical license is your livelihood. You worked extremely hard to earn it, and you rely on it day in and day out to provide the quality of care your patients need and deserve.

What would happen if it was taken away?

While this is a concern that never enters many doctors’ minds, for others it is a very real concern. Allegations of medical malpractice and other unethical or unlawful conduct can put doctors’ licenses in jeopardy, and avoiding license suspension or revocation requires a strategic defense executed by experienced legal counsel. While it is possible to resolve some allegations informally, in many cases it will be necessary to present a defense at a hearing before an administrative law judge (ALJ).

What is an ALJ Hearing in the Context of a Medical Malpractice Claim or Disciplinary Proceeding?

In the context of a medical malpractice claim or disciplinary proceeding, an ALJ hearing is a formal proceeding in which the ALJ will decide whether you should retain your license to practice medicine. Several state medical boards utilize this process in licensing matters, including those involving allegations of medical malpractice, billing fraud, and other types of prohibited conduct.

The potential outcomes of an ALJ hearing depend on the specific allegations involved as well as your personal disciplinary history. If it is not possible to avoid licensing action entirely, then a reprimand, written warning, license suspension, and license revocation are all possibilities. Specific penalties – and the specific acts and omissions that can lead to these penalties – are determined at the state level. While there are some uniformities, medical ethics and licensing rules are not necessarily consistent from one state to the next. As a result, in order to understand what is at risk in your ALJ hearing, you will need to discuss your situation with an experienced medical license defense attorney.

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Dr. Nick Oberheiden

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U.S. Department of Justice

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Former U.S. Attorney

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Aaron L. Wiley

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Chris Quick

Former Special Agent (FBI & IRS-CI)

Kevin M. Sheridan

Former Special Agent (FBI)

Ray Yuen

Former Supervisory Special Agent (FBI)

Dennis A. Wichern

Former Special Agent-in-Charge (DEA)

What Types of Issues Can Lead to ALJ Hearings for Doctors?

Numerous issues can lead to ALJ hearings for doctors. While state rules vary, generally speaking, the same types of misconduct have the potential to lead to disciplinary action (and the need to defend your medical license at an ALJ hearing) regardless of where you practice. Some of the most-common examples of these types of misconduct include:

• Practicing without a valid medical license
• Providing patient care while impaired by alcohol or drugs
• Failure to diagnose, misdiagnosis, delayed diagnosis and other diagnostic errors that fall below the applicable standard of care
• Fraudulently billing Medicare, Medicaid, Tricare, or a private healthcare insurer
• Treatment and surgical errors that fall below the applicable standard of care
• Medical malpractice involving prescription medications
• Sexual misconduct involving staff members or patients

When faced with any of these (or any other) allegations of misconduct as a doctor, it is imperative not to make assumptions in either direction. If you assume that you met the requisite standard of care, you run the risk of an ALJ deciding otherwise without the benefit of the evidence that you can present in your defense. If you assume that you committed an ethical or legal violation and await the consequences, the outcome could be far worse than necessary.

What Do You Need to Do in Order to Obtain an ALJ Hearing?

With this in mind, what do you need to do in order to obtain an ALJ hearing when faced allegations of medical malpractice or other unethical or unlawful conduct? The specifics vary from state to state. However, in many cases, it will be necessary to formally request an ALJ hearing in order to present evidence and arguments in your defense.

In California, for example, if a doctor is facing disciplinary action for a violation of the state’s Medical Practice Act, the doctor must request an ALJ hearing within 15 days of being formally served with the accusation. The request must be made by submitting a “Notice of Defense” to both the Office of the Deputy Attorney General and the California Medical Board. As the California Medical Board explains, “If a request for a hearing (or Notice of Defense) is not received, the physician will be deemed to have waived the right to a hearing and the Board may proceed to act on the accusation without a hearing and may take action as provided by law.”

Many other states have similar requirements; and, as a result, when facing allegations of malpractice or other misconduct, it is essential to proactively determine what steps are necessary in order to protect your license to practice medicine. Failure to do so may result in the suspension or revocation of your license without an ALJ hearing.

Can an ALJ Make a Decision Without a Hearing?

As indicated above, in certain circumstances, an ALJ or state medical board can make a decision without conducting a hearing. Whether this is a possibility depends on the specific rules and procedures in your state. Additionally, if you have a hearing scheduled and you fail to appear, then the ALJ can enter the equivalent of a default judgment and take adverse licensing action based upon the allegations against you.

When facing disciplinary action as a doctor, you need to do everything possible to protect your license. You need to request a hearing if it is necessary to do so, and you need to make sure you appear fully prepared to defend against the allegations at hand. You have the right to legal representation during your ALJ hearing, and it is strongly in your best interests to engage an experienced medical license defense attorney to develop and execute a strategic defense on your behalf.

Is it Possible to Settle Allegations Pending Before a Medical Board ALJ?

While procedures vary from state to state, in many cases it will be possible to settle allegations pending before a medical board ALJ. If the allegations against you can be substantiated (and it is therefore not possible to avoid sanctions entirely), then it may be in your best interests to work with your defense counsel to negotiate a settlement. This avoids the uncertainty of going to a decision following your ALJ hearing, and it affords you the opportunity to have a say in the sanctions that are imposed. In many cases, proactively approaching settlement prior to or during an ALJ hearing can result in a significant reduction in sanctions compared to what might otherwise be imposed.

Can a Decision by an ALJ Be Overturned?

Yes, if you receive an unfavorable result at a medical board ALJ hearing, it is possible to challenge the outcome and seek to have the ALJ’s decision overturned. The procedures and timelines vary by state; and, again, you will want to work with experienced medical license defense counsel to ensure that you do what is required. If necessary, you can ultimately take your case to court and go through the judicial appeals process to seek to have your adverse licensing action overturned.

How Do You Appeal a Medical Board ALJ Decision?

While it is possible to challenge the suspension or revocation of a medical license, in order to do so you must preserve your right to appeal. Appeal procedures vary by state, and the deadline for filing notice of appeal (or other required filing) is determined by state law as well. To avoid waiving your appellate rights, you should consult with a medical license defense attorney as soon after receiving the ALJ’s decision as possible.

Recap: 5 Key Takeaways about ALJ Hearings for Doctors

In summary, as a doctor, facing allegations of medical malpractice or other unlawful or unethical conduct presents many challenges. In many cases, the best way to protect yourself will be to assert a strategic defense at your ALJ hearing. Here are five key takeaways to keep in mind:

• You may need to request an ALJ hearing. If you are facing allegations of malpractice or other impropriety which have been raised by or referred to your state medical board, you may need to request an ALJ hearing in order to avoid license suspension or revocation.
• You may have a limited time window to request an ALJ hearing. If your state’s laws or rules require you request an ALJ hearing, you only have a limited amount of time to do so. If you fail to submit a timely request, you will be deemed to have waived your right to a hearing.
• ALJ hearings can have various outcomes. While ALJ hearings can result in various sanctions, it may be possible to protect your license as well. In some cases, settlement may also be a good option.
• You have the right to legal representation at your ALJ hearing. When preparing for your ALJ hearing, it is important to do so with the advice and representation of experienced medical license defense counsel.
• If you lose your medical license at an ALJ hearing, you can file an appeal. If an ALJ suspends or revokes your medical license at a hearing, you have the right to file an appeal. You will need to consult with an attorney promptly to make sure you preserve your appellate rights.

Speak with a Senior Medical License Defense Attorney at Oberheiden P.C.

Is your medical license at risk? If so, the senior medical license defense attorneys at Oberheiden P.C. can fight to protect your license at your ALJ hearing. To discuss your situation in confidence, call 888-680-1745 or request a confidential consultation online now.