Healthcare Worker Background Checks
Healthcare worker background checks are most often required by state regulations rather than federal regulations but, in some circumstances, can also be a condition of participation in Medicare and Medicaid or a condition of participation in a federal grant program. Because state regulations vary in content and applicability, there is no one-size-fits-all process for conducting background checks for healthcare workers.
Every healthcare provider is legally required to conduct pre-employment and repeat healthcare worker background checks to ensure the integrity of care and patient well-being, and also to mitigate the risks of insider theft and fraud. Beyond the mandated requirements, healthcare providers can choose to conduct additional advisory healthcare worker background checks depending on the healthcare worker’s roles and responsibilities.
Mandated Healthcare Worker Background Checks
Mandated healthcare worker background checks most often consist of searches of criminal history databases, checks against sex offender and child abuse registries, and credential verification. The nature of these checks can vary by state. For example, some states require prospective employees to undergo criminal history searches by name and by fingerprint; and, in some cases, both types of search are conducted on state and national databases.
It is important to be aware which state rules apply for healthcare worker background checks because when a criminal background check is a condition of participation of Medicare and Medicaid, or a condition of a federal grant, HHS requires providers to obtain criminal background checks “in accordance with state requirements” or, in the absence of state requirements, “for all states that the individual has lived or worked in the past 3 years”.
Checks Against State and Federal Exclusion Lists
Checks against state and federal exclusion lists are not mandated by most states, but they are strongly advised. Employing an individual or entity excluded from the HHS OIG Exclusions List can result in healthcare organizations having to repay three times the amount claimed from a federal healthcare program, civil financial penalties, and the potential exclusion for the healthcare organization if it tries to cover up its error.
The reason why it may also be necessary to check state federal exclusion lists is that, due to a prolonged appeals process, it can take up to two years for an individual or entity who is barred from working in healthcare in the state to appear on the federal exclusions list. Other databases that should also be reviewed for exclusions include the Medicare Exclusion Database, the System for Award Management database, and the National Practitioner Data Bank.
Advisory Background Checks for Healthcare Workers
Advisory background checks for healthcare workers include employment history verification (or educational history if a candidate has not previously been employed), a credit history check to assess candidates’ financial stability, and a driver’s license check if the role being applied for involves collecting, returning, or transferring patients (etc.) in an organization-owned vehicle and the organization would be liable in the event of an accident.
Drug screening background checks for healthcare workers can be important if a job candidate will have authorized access to controlled substances, if the organization receives federal grants under the Drug-Free Workplace Act, or if it participates in a program in which drug-free organizations qualify for a discount on workers’ compensation payments. Healthcare organizations also have the discretion to require drug screening as a workplace policy.
Repeat Healthcare Employee Background Checks
Repeat healthcare employee background checks can be mandatory or advisory depending on state regulations, the role of the healthcare employee, and workplace policies. Most states require repeat criminal history checks – some requiring the healthcare providers subscribe to a real time Rap Back system for certain categories of healthcare employees. It is also advisable to repeat credit checks periodically and reviews of exclusion databases monthly.
The challenge with repeat healthcare employee background checks is that the administrative burden can overwhelm an HR or compliance department. For this reason, many healthcare organizations have adopted software to automate background checks for healthcare employees. These solutions reduce the time spent conducting background checks, improve their accuracy, and ensure compliance with the Fair Credit Reporting Act.
Healthcare organizations with concerns that their existing pre-employment and repeat screening processes may not be adequate for the volume of state-mandated checks, or who would like to expand their current healthcare employee background checks to include more advisory checks, should speak with a selection of software providers and request a demo of their software in action to evaluate its uses and possible cost-saving benefits.
