The Texas Employee Misconduct Registry is a public database, maintained by the Texas Health and Human Services Commission (HHSC), that lists unlicensed healthcare workers found to have committed abuse, neglect, or exploitation of a person in their care. A listing bars you from working in any HHSC-regulated setting, including nursing homes, assisted living facilities, and home health agencies.1Cornell Law School. 26 Tex. Admin. Code 561.1 – Purpose The bar is indefinite unless HHSC agrees to remove you.
What Puts Someone on the Registry
The rules governing the registry sit in Title 26 of the Texas Administrative Code, Chapter 561, and the conduct definitions come from Texas Human Resources Code Chapter 48. HHSC recognizes three categories.
Abuse
Abuse covers physical harm, sexual misconduct, and conduct that causes serious emotional distress. The statutory definition includes deliberately injuring someone, unreasonable confinement, intimidation, and any nonconsensual sexual contact.2Justia. Texas Human Resources Code Chapter 48 – Investigations and Protective Services for Elderly and Disabled Persons A caregiver who strikes a resident, makes sexual advances, or threatens a patient into silence can face an abuse finding.
Neglect
Neglect means failing to provide goods or services necessary to avoid physical or emotional harm: skipping scheduled medication, ignoring hygiene needs, or leaving a person with limited mobility in an unsafe position for hours. The question is whether the failure created a real risk of harm, not just whether the outcome happened to be bad.2Justia. Texas Human Resources Code Chapter 48 – Investigations and Protective Services for Elderly and Disabled Persons
Exploitation
Exploitation is the improper use of a care recipient’s resources for personal benefit without informed consent. Spending a patient’s money without authorization, pressuring someone into signing financial documents, or redirecting benefit payments all qualify. Even small-dollar misuse of a patient’s debit card counts if it involves deception or a breach of the caregiver’s position of trust.2Justia. Texas Human Resources Code Chapter 48 – Investigations and Protective Services for Elderly and Disabled Persons
How a Case Becomes a Listing
A case starts when someone reports an allegation to HHSC. Investigators review records, take witness statements, and may interview the accused employee, the alleged victim, and coworkers. If they find enough evidence that reportable conduct occurred, HHSC issues a written finding and mails notice to the employee.3Cornell Law School. 26 Tex. Admin. Code 561.7 – Reportable Conduct Finding and Notice and Opportunity for Administrative Hearing
Read that notice carefully. It states the alleged conduct and tells you that you have 30 calendar days to request a hearing in writing.3Cornell Law School. 26 Tex. Admin. Code 561.7 – Reportable Conduct Finding and Notice and Opportunity for Administrative Hearing Missing that window is the single most costly mistake in the process. Once 30 days pass without a written request, the finding becomes final and your name goes on the registry with no further chance to contest it.
HHSC can also enter a name based on findings from the Texas Department of Family and Protective Services, from another state’s agency, or from the federal government, without offering a separate HHSC hearing in those situations.4Cornell Law School. 26 Tex. Admin. Code 561.8 – Entering Information in the EMR
The Hearing
If you request a hearing on time, the case goes to the State Office of Administrative Hearings (SOAH). An administrative law judge runs a proceeding that resembles a civil trial: both sides present evidence and call witnesses, and HHSC carries the burden of proving that reportable conduct occurred.3Cornell Law School. 26 Tex. Admin. Code 561.7 – Reportable Conduct Finding and Notice and Opportunity for Administrative Hearing
The judge issues findings of fact, conclusions of law, and a recommendation. HHSC makes the final decision and may accept or modify what the judge recommended.3Cornell Law School. 26 Tex. Admin. Code 561.7 – Reportable Conduct Finding and Notice and Opportunity for Administrative Hearing An unfavorable outcome can be appealed to the Texas courts, but courts give significant deference to agency findings, so judicial review is an uphill fight.
Texas Health and Safety Code Chapter 253 also directs HHSC to adopt procedures for informal proceedings, which can sometimes resolve a dispute before a formal SOAH hearing.5State of Texas. Texas Health and Safety Code Section 253.006 – Informal Proceedings
What a Listing Costs You
Facilities, home health agencies, and individual employers are prohibited from hiring anyone whose name appears on the registry.6State of Texas. Texas Health and Safety Code Section 253.008 – Verification of Employability; Annual Search The bar is not time-limited. Unless HHSC removes your name, the listing stays.
Professional licensing boards frequently look at registry findings when reviewing applications and renewals. The Texas Board of Nursing, for example, may open its own disciplinary proceeding based on an EMR finding. The registry doesn’t revoke a license by itself, but it gives a licensing board a documented basis to act, and many people listed on the EMR end up facing both consequences at once.
The financial impact is often severe. Caregiving is the primary skill set for many listed workers, and moving to unregulated work usually means a significant pay cut. Background check services may also surface an EMR listing for employers outside healthcare.
Crossing State Lines Won’t Fix It
Leaving Texas doesn’t clear the problem. HHSC can enter other states’ findings into the Texas EMR, and other states can look at Texas findings when making their own decisions.4Cornell Law School. 26 Tex. Admin. Code 561.8 – Entering Information in the EMR There is no formal nationwide reciprocity system for misconduct registries, but many states check other jurisdictions during background screening.
Federal Exclusion Can Stack on Top
A Texas EMR listing is a state consequence, but the same conduct can also trigger federal exclusion from Medicare and Medicaid through the Office of Inspector General (OIG). A criminal conviction related to patient abuse or neglect triggers a mandatory five-year federal exclusion, a second conviction extends it to ten years, and a third results in permanent exclusion.7U.S. Department of Health and Human Services, Office of Inspector General. Exclusion Authorities
The OIG’s mandatory exclusion criteria require a criminal conviction, not just an administrative finding, so not every EMR listing produces federal exclusion. But where the same facts lead to both a state registry entry and criminal charges, the federal consequences layer on top of the state ones. Facilities that bill federal programs for services delivered by an excluded person face civil monetary penalties of up to $25,595 per item or service, plus an assessment of up to three times the amount claimed.8Federal Register. Annual Civil Monetary Penalties Inflation Adjustment The facility itself can also be excluded from federal programs.9Office of Inspector General. The Effect of Exclusion From Participation in Federal Health Care Programs That is why employers screen against the OIG list in addition to the state registries.
Getting Off the Registry
Removal is difficult, but the door is not closed. Texas Health and Safety Code Section 253.010 lets a listed person submit a written request asking HHSC to remove them, and HHSC can grant the request if it determines the person no longer meets the requirements for inclusion.10Texas Public Law. Texas Health and Safety Code Section 253.010 – Removal from Registry The statute gives HHSC’s executive commissioner authority to set the specific criteria by rule.
Successful petitions are uncommon. HHSC has broad discretion and no obligation to grant a request. Where the original finding was based on solid evidence and upheld at a hearing, a listed person faces a steep burden in showing that the requirements for inclusion are no longer met.
A person who believes the process itself was flawed can pursue judicial review in Texas district court, arguing that HHSC’s decision was not supported by substantial evidence or that the agency violated procedural requirements. If the original finding is overturned in a separate legal proceeding, that outcome can also support removal from the registry.
What Employers Have to Do
Before hiring, a facility, agency, or individual employer covered by Chapter 253 must search both the EMR and the Nurse Aide Registry to confirm the applicant is not listed for abuse, neglect, or exploitation. If the person appears in either registry, hiring is prohibited.6State of Texas. Texas Health and Safety Code Section 253.008 – Verification of Employability; Annual Search The check must be repeated annually for existing employees, and the results kept on file.11Cornell Law School. 26 Tex. Admin. Code 506.36 – Criminal History and Nurse Aide Registry Checks of Employees and Applicants for Employment
Employers also have to notify their workforce that appearing on the registry makes a person ineligible for employment.12Texas Public Law. Texas Health and Safety Code Section 253.009 – Notification Failing to check the registry or knowingly employing a listed individual can lead to administrative penalties, including fines and potential loss of the facility’s license. HHSC provides a public online search tool anyone can use to look up registry status; that public search is separate from the formal employability check employers must document.