Ability in the local national language is a central object for discourses that de/legitimise immigrants and shape ideas of social reality and social action. In the context of Swedish health care settings, examples of reported speech from patients are offered to show how a presumed migrant’s accent in speaking a national language is conceptually multi-valent in terms of the regulation of legitimacy. Staff who are presumed to be migrants are regularly de-legitimised on the grounds of their speaking style, with foreign accents emphasised as a sign of illegitimacy. Staff who speak without an accent are de-legitimised as speaking Swedish that is too fluent to be compatible with status as an immigrant. The delegitimising of both accented and unaccented language in health care settings indicates the exclusionary and racist nature of language practice, mobilised to delegitimise presumed migrants.