OIG Releases Criminal Background Check Study on Home Health Agencies
May 27, 2015 07:27 AM
The Office of Inspector General (OIG) has issued a report titled Home Health Agencies Conducted Background Checks Of Varying Types. The evaluation is in response to a congressional request for the Office of Inspector General (OIG) to analyze the extent to which HHAs employed individuals with criminal convictions and whether these convictions should have disqualified them from HHA employment. This report is a companion to the May 2014 report entitled State Requirements for Conducting Background Checks on Home Health Agency Employees, which identified State background-check requirements for HHAs and identified the types of criminal convictions that, under State law or regulation, disqualify individuals from HHA employment.
In general, there are two types of background checks that States may require HHAs to use: statewide and Federal Bureau of Investigation (FBI). Statewide background checks are typically conducted by a State law enforcement agency and include information for crimes committed within that State. For an FBI background check, a State law enforcement agency initiates the process by providing the FBI with an individual’s identifying information and a set of fingerprints. The FBI checks them against the criminal background information maintained in its database and sends the results back to the State law enforcement agency. The FBI’s database includes information both on Federal crimes and State-reported crimes from all States.
In addition, the Affordable Care Act established the Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers (National Background Check Program). This voluntary program awards grant funds to States to conduct background checks on prospective long-term-care employees. Under the program, prospective “direct patient access” employees in any of 10 provider types (e.g., HHAs) must undergo fingerprint-based statewide and FBI background checks, as well as checks of State-based registries of abuse and neglect. CMS began awarding grants to States in September 2010. As of April 2015, CMS had awarded grants to 25 States, totaling more than $50 million.
For the study, the OIG selected a random sample of 105 HHAs from the national population of 12,626 Medicare-certified HHAs that were in operation on January 1, 2014. Six of the sampled HHAs were ineligible, reducing the size of the usable sample 99 HHAs. From the 99 sampled HHAs, responses to a survey about background check procedures and information on all employees as of January 1, 2014, were collected. The 99 HHAs reported a total of 4,680 employees.
The report found that all HHAs conducted background checks of varying types on prospective employees; approximately half also conducted periodic checks after the date of hire. All HHAs reported conducting either a statewide or Federal criminal background check, or both. Eighty-three percent of HHAs conducted background checks on all prospective employees, and an additional 9 percent conducted background checks only on direct-care employees. The remaining 8 percent conducted background checks on a specific group of individuals, such as unlicensed direct-care staff.
Fifty-eight percent of HHAs conducted periodic background checks after the date of hire. Of the HHAs that conducted periodic background checks, 44 percent conducted annual checks, and a quarter of HHAs conducted checks more frequently than annually. Eleven percent of the HHAs that conducted periodic checks had terminated at least one employee based on the results of a periodic check.
Seventy-two percent of HHAs did not allow employees to begin work prior to completion of the background check. Of the 28 sampled HHAs that allowed employees to begin work pending the completion of the background check, nine stipulated that direct-care employees were not allowed to begin patient care until their background checks were complete.
Four percent of HHA employees had at least one conviction in FBI-maintained criminal history records. Employees with at least one conviction in their criminal history records averaged two convictions per employee. The number of criminal convictions per employee in the sample ranged from 1 to 13.
Based on the findings the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) promote minimum standards in background check procedures. CMS could promote minimum standards for HHA employee background checks by encouraging more States to participate in the National Background Check Program. CMS concurred with the OIG’s recommendation.
To view the report click here.