Provider Revalidation Concern Intake Form
This form is intended for legislators and legislative assistants to document constituent concerns related to provider revalidation, licensing, termination, or appeal issues. Please complete all applicable fields and copy the full body of any email received into the description section. Supporting documents, notices, appeal letters, and other relevant materials should be attached whenever available. The information collected will help our office identify patterns, track cases, and advocate effectively on behalf of providers experiencing revalidation challenges.
REMINDER: Many types of data held by the government are not public. That includes educational data, medical data, data on people receiving public benefits, some grant data, and a variety of other information. While specific details about potential fraud may be important to criminal investigations, providing information about potential fraud does not mean potential whistleblowers can share data that is confidential or otherwise protected. Please avoid sharing that type of detailed information unless that information comes from a public source.