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Working with State Health Care Professional Licensing Authorities

HHS-OIG has the authority to exclude individuals and entities from Federally funded health care programs if a State licensing authority has taken one of the following actions regarding an individual or entity's license to provide health care:

  1. Revoked the license;
  2. Suspended the license;
  3. Otherwise caused an individual or entity to lose a license or the right to apply for or renew such a license; or
  4. Accepted the surrender of a license while a disciplinary proceeding was pending.

The reasons for the revocation, suspension, surrender, or other loss of a health care license must concern the individual or entity's:

  1. Professional competence;
  2. Professional performance; or
  3. Financial integrity.

Actions such as placing a license on probation, issuing letters of censure, or imposing conditions short of suspension, revocation, or surrender are not a statutory basis for exclusion from the Federal health care programs and should not result in referrals to the OIG.

The OIG needs the following documents to process the exclusion:

  1. The Order or other official document imposing the revocation or suspension, accepting the surrender, or otherwise resulting in the loss of a health care license or the right to apply or renew such a license;
  2. Any charging document (or amended charging document) that was the basis of the license actions.

If those documents don't clearly demonstrate that the revocation or suspension was related to the reasons set forth above, then any other document that establishes such a relationship can be provided. These could include:

  1. Investigative reports;
  2. Minutes/transcripts of meetings/hearings/interviews;
  3. Any other document which demonstrates the required relationships.

If the document contains Personally Identifiable Information (PII) or Protected Health care Information (PHI), please contact the OIG to arrange to use the OIG's secure server to transmit the documents rather than sending them by e-mail.