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Home Health Agencies Conducted Background Checks of Varying Types


Employees of home health agencies (HHAs) provide care-usually unsupervised-to patients in their homes. Ensuring that HHA employees have undergone a minimum level of screening would help protect the safety of Medicare beneficiaries. There are no Federal laws or regulations that require HHAs to conduct background checks prior to hiring individuals or to periodically conduct background checks after individuals have been hired. State requirements for background checks vary as to what sources of information must be checked, which job positions require background checks, and what types of convictions prohibit employment. This evaluation is in response to a congressional request for OIG to analyze the extent to which HHAs employed individuals with criminal convictions and to explore whether these convictions should have-according to State requirements-disqualified them from HHA employment.


We requested data from a sample of Medicare-certified HHAs regarding all individuals they employed on January 1, 2014. We compared the employee data with criminal history records from the Federal Bureau of Investigation (FBI) to identify individuals with criminal convictions who were employed by the sampled HHAs. We selected for an indepth review six employees who had convictions for crimes against persons in the last 5 years and/or were registered sex offenders. We evaluated whether compliance with State laws would have led to disqualification of these six employees.


All HHAs conducted background checks of varying types on prospective employees; approximately half also conducted periodic checks after the date of hire. Four percent of HHA employees had at least one criminal conviction; such convictions may or may not have disqualified them from employment. FBI criminal history records were not detailed enough to enable us to definitively determine whether employees with criminal convictions should have been disqualified from HHA employment. Our review of the six selected HHA employees found that three have convictions for crimes against persons that appear-on the basis of available data-to disqualify them from employment in HHAs; however, circumstances may have allowed their employment. The remaining three individuals' convictions did not disqualify them from employment in their respective States.


We recommend that 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 our recommendation.