I Failed a BBS CE Audit: What California Clinicians Should Know

Ana Hinshaw
17 hours ago
10 min read

Updated: 16 hours ago

I never expected to write a post like this. But after sharing my experience with several colleagues, and hearing the same reaction again and again (“Wait…that can really happen?”), I decided it needed to be written down.

I’m writing this because California clinicians deserve clear, accurate information about what actually happens when you fail a continuing education (CE) audit.

I am a licensed California clinician. I am also licensed in multiple states, which means I track CE carefully and in good faith. Despite that, I failed a CE audit conducted by the California Board of Behavioral Sciences (BBS) after submitting a course I believed met CE requirements based on the BBS CE guidance webpage. However, under the criteria applied in my audit, the course was not accepted, leaving me three hours short of the required 36.

I paid the fine, completed a replacement three-hour course, submitted my waiver of appeal, and reasonably believed that would be the end of the matter.

It was not.

Because CE citations (even when corrected and resolved) are publicly posted in California, my citation triggered a report by BBS to the National Practitioner Data Bank (NPDB).

The NPDB is a confidential federal database created to promote patient safety by tracking certain negative actions related to licensed healthcare professionals, such as malpractice payments, license discipline, or serious professional misconduct. It is primarily used by hospitals, employers, and insurance companies during credentialing and hiring decisions. It is not a public registry used by patients.¹

Importantly, the NPDB states that “reports in the NPDB do not expire. Information reported to the NPDB is maintained permanently unless corrected or voided.”²

Within the same month my citation was marked “resolved,” I learned how significant the downstream consequences of an NPDB report can be. My goal in writing this is to make California clinicians aware of those consequences, so that they (and importantly their patients) are not blindsided in the same way.

This post is not a rant. It is not legal advice. And it is not an attempt to avoid responsibility. I complied with the audit and accepted the outcome. What this is is an effort to share information I wish I had known earlier. Because the consequences of a failed CE audit in California are more serious than many clinicians realize.

The Short Version (If You’re Already Tired)

If you fail a CE audit in California, the outcome involves:

A monetary fine (in my review of a sample of publicly available citations, I’ve seen as low as $150 and as high as $1,200)
A public citation posted on the BBS website for five years
A report to the National Practitioner Data Bank (NPDB) that is retained indefinitely²

An NPDB report may be considered by employers or insurance companies when making credentialing or contracting decisions, even when there is no allegation of clinical misconduct or patient harm.³

I did not fully understand this before my audit. I suspect many clinicians do not either.

A Simple Analogy (Because This Is Hard to Grasp)

Imagine you receive a parking ticket. You read the signs, believe you followed the rules, but later learn that a critical detail was posted somewhere you didn’t see. You acknowledge the mistake. You pay the fine. You correct the issue.

Now imagine that instead of the matter ending there, your name is posted publicly for five years. A permanent national record is created. And that record can later be used by your employer to legally terminate your job.

That is how a resolved CE citation can function in California.

According to BBS materials, CE citations are administrative. However, in practice, the consequences can resemble those associated with disciplinary actions.

What Happened to Me

After my citation was marked “resolved,” I received notices from my insurance partners indicating that credentialing reviews had been initiated due to the NPDB report associated with the citation. These reviews were triggered by the existence of the NPDB report itself, not by any complaint, patient harm, or clinical concern.

I provided each reviewing entity with documentation showing that the citation had been fully resolved and that it involved an administrative CE deficiency only. Despite this, one insurance partner terminated my contract. (All other reviews ultimately passed, and those contracts remain in place.) In my case, the termination resulted in an abrupt end to patient care under that plan and the loss of an income source, despite the absence of any allegation related to quality of care or patient safety.

After sharing this experience with colleagues (both in and out of California), a few of them urged me to seek legal consultation and guidance from my professional liability carrier. I also wanted to better understand whether this outcome was unusual or improper.

I was advised that termination, contract nonrenewal, and even professional liability insurance nonrenewal based on the existence of an NPDB may be lawful (depending on the contract and other legal protections) even when the underlying matter is administrative and resolved.⁴

What Was Missing: Clarity

One of the most difficult aspects of this process was the lack of a clear explanation about why my course was deemed unacceptable.

I was informed that the audit failed and that I owed a fine and three hours of CE, but I did not receive a plain-language explanation of what specifically made the course non-compliant. Based on the BBS CE guidance page, the provider appeared to meet the indicators of approval described there, which added to the confusion.

I attempted to obtain clarification directly from BBS. Ultimately, I was left to piece together the reasoning on my own.

To better understand how my audit had been conducted, I submitted a Public Records Act (PRA) request and paid the BBS $87 to obtain additional documentation. Even with those records, I did not receive a clear enough explanation of why the course was rejected.

This lack of clarity prompted me to do deeper research.

What I Didn’t Know, and Wish I Had

Before this experience, I did not fully understand several critical facts:

In California, CE citations (even when corrected) are considered “publicly available adverse actions” for reporting purposes⁵
These citations may be reported to the NPDB
NPDB reports are retained indefinitely²
Resolution of a citation does not remove an NPDB report
Employers and insurance companies may legally consider NPDB reports when making credentialing or contracting decisions
They are not required to weigh context or proportionality

In other words, “resolved” in name does not necessarily mean resolved in practice.

A Brief Reality Check From Legal Consultation

After this occurred, I consulted with attorneys and professionals familiar with healthcare licensing and credentialing.

I was advised that:

There is no mechanism to automatically remove or expire an NPDB report (for resolved CE citations) once submitted
Administrative citations may be reported even without misconduct
Employers and insurers may lawfully terminate or deny contracts based on NPDB reports
Once appeal rights are waived or exhausted, options are extremely limited

This is not about bad actors or loopholes. It reflects how the current system operates.

When the Consequences Extend Beyond the Board

After one insurance partner terminated my contract, I notified both BBS and the Department of Consumer Affairs (DCA).

In written correspondence, I was informed that because the termination occurred outside the Board’s regulatory authority, it was considered outside the jurisdiction of the BBS.⁵

This response raised a broader concern. BBS emphasizes its role in protecting the public. In my case, the downstream effect of a resolved administrative citation was disruption to patient care and reduced access to services – outcomes that directly affect the public.

This raises a reasonable oversight question about how downstream impacts are considered when administrative enforcement actions are taken.

This Is Not a Rare Event

Publicly reported data indicates that CE audit failures in California are not isolated.

Earlier audit cycles reflected lower failure rates, while more recent audit periods (following significant changes to CE oversight) have reported failure rates beyond 40%. These figures are drawn directly from BBS Sunset Review Reports (2019 and 2025) and related legislative background materials.⁶

When a large proportion of audited clinicians fail to meet documentation or approval standards, it suggests a systemic clarity challenge, rather than widespread disregard for professional responsibility.

CE Oversight Changes and the “Moving Target” Problem

In 2015, BBS ceased approving individual CE providers and courses. Licensees were required to rely on approval agencies and provider documentation to infer compliance.⁷

Subsequent Sunset Review Reports and legislative oversight discussions raised concerns about how approval agencies are monitored, how licensees are informed of compliance standards, and whether regulatory language is sufficiently clear.⁸

When compliance standards shift and guidance is fragmented, the risk of administrative error increases, even when clinicians act in good faith. At that point, clarity itself becomes a public-protection issue.

What the 2025 Sunset Review Report Acknowledges

The BBS 2025 Sunset Review Report provides important context.

The report confirms that CE compliance is evaluated primarily through indirect verification mechanisms:

“Bord [sic] recognized approval agencies evaluate and monitor continuing education providers to ensure courses meet professional and regulatory standards. Continuing education providers are responsible for offering compliant courses, maintaining records, and issuing completion certificates to licensees.”⁹

The report also notes that although the Board has authority to audit CE providers directly, that authority has not been exercised:

“While the Board has the authority to audit course records … it has not received any complaints or exercised this authority to audit providers to date.”¹⁰

In addition, the Sunset Review acknowledges that regulatory language has required clarification:

“Amendments to clarify language that has been identified as unclear or needing further detail.”¹¹

Taken together, these statements reflect an acknowledged structural challenge: clinicians are expected to ensure compliance based on indirect indicators, while aspects of the regulatory framework have been formally identified as unclear.

Viewed alongside persistently high audit failure rates, this suggests an issue that has been recognized at the oversight level and remains unresolved.

The Broader Context: California’s Behavioral Health Workforce

These enforcement outcomes do not occur in a vacuum.

According to the California Health Care Access and Information (HCAI), every region and county in California is projected to face a behavioral health workforce shortage, driven in part by provider maldistribution and insufficient workforce capacity.¹²

In that context, administrative enforcement actions that disrupt clinician employment, insurance participation, or continuity of care – particularly when no patient harm is involved – carry broader system-level implications.

Workforce stability and access to care are explicitly recognized priorities in the Board’s own strategic planning documents.¹³

What the Law Says and What It Does Not

Per written correspondence from BBS:

“Citations having a fine of $1,500 or less are required to be posted on the BBS website for a period of five (5) years from the date issued (per California Business and Professions Code Section 4990.09).”⁵˒¹⁴

This statute addresses public posting requirements. It does not require reporting to the NPDB.

Based on correspondence with BBS and DCA, legal consultation, and my review of available guidance, I was advised that reporting classification reflects administrative practice rather than a posting mandate. Because NPDB reports are retained indefinitely², these classification decisions carry long-term consequences.

Returning to the Parking Ticket Analogy

If drivers are expected to comply, the rules must be clear. Approved parking should be plainly marked. Consequences should be posted in advance.

Drivers should not have to dig through statutes, file public records requests, or guess after the fact whether a space was acceptable.

Maintaining clear, accessible guidance – such as examples of acceptable CE documentation or a current list of recognized approval agencies – is a modest administrative investment relative to the downstream consequences of ambiguity, including audit failures, workforce disruption, and reduced patient access to care.

When the cost of ambiguity is permanent federal reporting², contract termination, and disrupted patient care, clarity is not a courtesy. It is a responsibility.

Constructive Solutions: Clarity, Proportionality, and Public Protection

I support strong public protection standards, licensure oversight, and accountability when patient safety is at risk. What I am advocating for is better regulation – systems that are clear, proportional, and aligned with stated goals of transparency, equity, workforce stability, and access to care.

Practical, policy-focused improvements that could reduce avoidable CE audit failures while preserving public protection include:

Publishing clear, up-to-date guidance on CE approval pathways, including recognized approval agencies, an approved list of CE courses, examples of acceptable certificates, and common audit pitfalls
Providing transparent information about the audit process, timelines, and how fines are assessed
Treating corrected CE-only deficiencies that involve no patient harm as administrative compliance matters, rather than reportable negative actions
Reserving NPDB reporting for cases involving demonstrated patient safety risk or repeated, willful noncompliance
Considering workforce stability and access-to-care impacts when designing enforcement responses

These improvements would align with BBS’s Strategic Plan enforcement goals to protect the public, including: “Evaluate and establish internal policies and procedures related to enforcement issues to ensure an equitable process that reflects rehabilitation versus punitive measures for the purpose of consumer protection.”¹³

Maintaining clear, accessible guidance is a modest administrative investment relative to the downstream consequences of ambiguity, including audit failures, workforce disruption, and reduced patient access to care.

Final Thoughts

If you are a California clinician, I encourage you to review CE documentation carefully, ask explicit questions about audit consequences, and share accurate information with colleagues.

If you are in a policy or regulatory role, I hope this offers perspective on how these processes affect clinicians, as well as the patients who depend on them.

Clinicians are not disposable. Patients need them. Systems should support – not silently undermine – the workforce they rely on.

Disclaimer

This post is for educational and informational purposes only and does not constitute legal advice. I am sharing my personal experience and publicly available information to promote transparency and understanding. Clinicians facing audits or citations should consult qualified legal or professional advisors regarding their specific circumstances.

Sources

National Practitioner Data Bank, About the NPDB (https://www.npdb.hrsa.gov/topNavigation/aboutUs.jsp)
NPDB, When do reports expire? (https://www.npdb.hrsa.gov/faqs/d7.jsp)
NPDB Guidebook: State Licensure Actions (https://www.npdb.hrsa.gov/guidebook/EStateLicensureActions.jsp)
Legal and credentialing consultation (general guidance; not individualized legal advice)
Written correspondence with BBS and Department of Consumer Affairs (on file)
California Board of Behavioral Sciences, Sunset Review Reports (2015, 2019, 2025) (https://www.bbs.ca.gov/resources/general.html)
BBS 2015 Sunset Review Report (https://www.bbs.ca.gov/pdf/publications/bbs_2015_sunset_report.pdf)
BBS 2019 & 2025 Sunset Review Reports (https://www.bbs.ca.gov/pdf/publications/bbs_2019_sunset_report.pdf & https://www.bbs.ca.gov/pdf/publications/bbs_2025_sunset_report.pdf)
BBS 2025 Sunset Review Report, CE section (p. 66) (https://www.bbs.ca.gov/pdf/publications/bbs_2025_sunset_report.pdf)
BBS 2025 Sunset Review Report, CE oversight discussion (p. 67) (https://www.bbs.ca.gov/pdf/publications/bbs_2025_sunset_report.pdf)
BBS 2025 Sunset Review Report, Pending Regulations section (p. 17) (https://www.bbs.ca.gov/pdf/publications/bbs_2025_sunset_report.pdf)
California Health Care Access and Information (HCAI), Behavioral Health Workforce Supply & Demand Modeling (https://hcai.ca.gov/visualizations/supply-and-demand-modeling-for-californias-behavioral-health-workforce/)
California Board of Behavioral Sciences, Strategic Plan 2022–2026 (https://www.bbs.ca.gov/pdf/publications/splan_2022.pdf)
California Business & Professions Code § 4990.09 (https://codes.findlaw.com/ca/business-and-professions-code/bpc-sect-4990-09/; https://www.bbs.ca.gov/pdf/publications/lawsregs.pdf)