Background Checks for Healthcare Employees
Background checks for healthcare employees are an important safeguard in environments in which the well-being of patients and the integrity of the care are paramount. Pre-employment screening for healthcare workers – and frequent re-screening thereafter – can also help mitigate the risk of fraud and theft for healthcare organizations.
All healthcare providers are required to conduct background checks for healthcare employees. Most often these consist of state-mandated professional credential verification, and checks against criminal record databases and sex offender registries. Some states also mandate background checks against state and federal exclusion lists, or screening for abuse and neglect when prospective employees will have direct access to children or vulnerable adults.
In addition to state-mandated background checks for healthcare employees, some healthcare organizations conduct “advisory” background checks. These can include employment and education background checks, drug and addiction screening, credit reports, and driving records – especially when a job entails transporting patients, delivering medications or supplies, or traveling between sites and the healthcare organization will be liable in the event of an accident.
There are also federal regulations that require background checks for healthcare employees. For example, it is a condition of participation in Medicare and Medicaid that hospices conduct criminal background checks on all employees that have direct patient contact or access to patient records (42 CFR §418.114(d)). Long term care facilities that participate in CMS’ National Background Check Program are also required to conduct various background checks.
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The Purposes of Background Checks for Healthcare Employees
Background checks for healthcare employees are not just bureaucratic steps in the recruitment process. They ensure that every member of the workforce who interacts with patients – or who has access to patients’ records – is capable and trustworthy. In this respect, effective background checks for healthcare employees can help reduce patient safety events, maintain the reputation of the healthcare organization, and enhance regulatory compliance.
Patient Safety
By conducting thorough background checks for healthcare employees, healthcare organizations can identify potential risks that might compromise the standard of patient care. The process ensures candidates with a history of negligent, abusive, or fraudulent behavior are not employed, minimizes the risk of employing unqualified individuals, and increases the likelihood that caregivers possess the necessary skills to handle complex medical situations.
When members of the workforce are aware that stringent background checks are in place, it helps build a work culture of accountability and trust. This not only supports improved employee engagement, productivity, and retention, but it can also reduce burnout – which then reduces the number of adverse events and unintentional security incidents attributable to human error, which reassures patients about the quality of care they receive.
Maintain Reputation
A healthcare organization’s reputation is closely tied to the reliability and behavior of its staff. By scrutinizing potential hires, healthcare organizations can reduce the likelihood of incidents that might lead to malpractice, fraud, or other misconduct. This proactive approach not only helps an organization maintain its reputation, but can help to enhance it – giving the organization a competitive edge that can lead to increased patient volume and increased market share.
A good reputation in the healthcare industry does not just draw in patients. Talented physicians, nurses, and administrators are more likely to join and remain with a healthcare organization that has a good reputation. Similarly, local businesses, public health bodies, and academic institutions will want to create partnerships with the healthcare organization – further bolstering the organization’s reputation and the advantages that come from having a good reputation.
Regulatory Compliance
Conducting thorough background checks for healthcare employees is essential for regulatory compliance – not just because states and federal agencies mandate background checks, but also because checking prospective employees’ backgrounds increases the likelihood of a reliable and risk-managed workforce that adheres to both legal and ethical standards, and is more likely to comply with the requirements of HIPAA, OSHA, and other regulatory frameworks.
A thorough background check process makes prospective employees aware that the healthcare organization has a culture of accountability from the outset. When existing employees know that only candidates meeting strict standards are engaged, it fosters an environment of trust and professionalism. This contributes significantly to maintaining a safe work environment and reinforces the organization’s commitment to fulfilling its regulatory obligations.
What a Background Check for Hospital Employment Consists Of
What a background check for hospital employment consists of varies by state. In most cases, healthcare organizations are required to check criminal records and sex offender registries. More background checks may be necessary if a prospective employee is applying to work with children or vulnerable adults, or will have access to controlled substances. The thoroughness of each check is also determined by state regulations and laws regarding individual privacy.
Criminal History Check
This background check for hospital employment verifies if a candidate has any criminal records that could impact their ability to work in healthcare. Some states require healthcare organizations to check both state and federal criminal databases, while others may require a search by fingerprint as well as a search by name. A few (i.e., Georgia, Utah, etc.) require continuous monitoring via a Rap Back system for certain categories of healthcare employees.
Sex Offender and Abuse Registries
Most states require a background check for hospital employment to include a check against a state or federal sex offender registry (or both). In addition, many require abuse registry checks on prospective employees to identify any prior findings of abuse, neglect, or exploitation in a healthcare setting. Whether it is still possible to employ an offender or an abuser, and what roles they can be assigned, is governed by state regulations and hospital policies.
Professional License and Education Verification
All states require the verification of professional licenses and certifications for qualifying hospital roles. Some state requirements are more rigorous than others because they not only require the credentials are valid and current, but also that they are checked for authenticity. Other states may also require the verification of a candidate’s education records or other certifications when a candidate is applying for a non-medical role.
Employment History
It is not unusual for an employment background check to be more thorough in the healthcare industry than in other industries. Employers are often required to check the accuracy of a candidate’s resume and may contact past employers to learn about the candidate’s work ethic, performance, and reasons for leaving previous positions. This depth of scrutiny helps employers assess whether a candidate will be a reliable and stable addition to the existing workforce.
Drug Screening
Under the Drug-Free Workplace Act 1988, drug screening is mandatory for organizations that receive grants from the federal government (not including Medicare reimbursement payments). Additionally, some states offer discounts on workers’ compensation premiums if an organization implements a drug-free workplace program, while some healthcare organizations may include screening in a background check for hospital employment to enhance patient safety.
Exclusion List Check
While healthcare organizations are advised to check the HHS OIG Exclusion List to avoid engaging an individual who is prohibited from participating in federal health care programs, several states maintain their own exclusion lists and mandate that new hires in specific occupations are checked against these lists. Examples include the Statewide Central Register and Staff Exclusion List in New York, and the Healthcare Provider Exclusion List in Colorado.
Credit History Checks
Although no state maintains credit history checks are included in a background check for hospital employment, some organizations may conduct a credit history check to assess financial stability and mitigate the risk of fraud and theft. Additionally, credit history checks can indicate whether a candidate for employment has good history of responsibility and judgement – a consideration that may enhance the candidate’s employment prospects.
Repeat Background Checks for Healthcare Workers
Most states mandate repeat background checks for healthcare workers. These may consist of the previously mentioned monitoring of Rap Back systems, periodic reviews of licensing credentials, or drug screening as part of a drug-free workplace program. However, even when repeat checks are not mandated, it is a best practice in the healthcare industry to implement a policy for repeating most types of background checks for healthcare workers.
This is because, while an initial background check can confirm a candidate’s suitability at the time of hire, circumstances can change over time. Furthermore, due to lengthy appeals processes, it can take up to two years for an individual convicted of healthcare fraud or patient abuse to appear on an exclusions list. A worker may also be subsequently convicted of a criminal offense, be subject to disciplinary action, or start experiencing financial difficulties.
Repeat background checks for healthcare workers ensure that any such developments are promptly identified and addressed, and act as an ongoing safety net to ensure compliance with ethical, professional, and regulatory standards is maintained. A repeat background check can reveal any shifts in a worker’s history that might compromise the safety of patients, the overall quality of care, or expose the healthcare organization to legal or reputational risks.
Challenges with Pre-Employment Screening for Healthcare Workers
While background checks for healthcare employees are necessary for patient safety, an organization’s reputation, and regulatory compliance, there can also be challenges with pre-employment screening for healthcare workers that reduce the thoroughness of background checks. The challenges are most often attributable to the requirements of the federal Fair Credit Reporting Act, and state “Ban the Box” and “Fair Chance” laws (which can also be enacted by cities).
The Fair Credit Reporting Act provides a federal floor of privacy safeguards for job applicants, and requires that prospective employers obtain an informed authorization from job applicants before conducting pre-employment screening for healthcare workers. It also includes regulations relating to “adverse action procedures”, job candidates’ rights to dispute an adverse action, how information can only be used for the disclosed purpose, and data confidentiality.
States and cities with “Ban the Box” and “Fair Chance” laws – and other laws such as California’s Fair Employment and Housing Act – place further limitations of what information an employer can request and what it can be used for. For example, in New York, stricter limitations apply to what information can be disclosed to prospective employers about a job candidate’s criminal history, their mental health, and their background in drug or alcohol addiction.
Automated Background Checks for Healthcare Employees
In 2013, HHS’ Office of Inspector General issued a Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs. The Advisory Bulletin recommends that healthcare providers check the HHS OIG Exclusion List prior to employing a new member of the workforce or contacting a healthcare service, and that screening employees and contractors each month best minimizes potential overpayment and CMP liability.
Manually checking the HHS OIG Exclusion List – and any other databases that may be required by state law (i.e., Rap Back systems) – places a significant administrative burden on healthcare organizations with large workforces. For this reason, many healthcare organizations have taken advantage of automated background checks for healthcare employees which speed up the screening process and ensure that organizations remain updated with evolving regulations.
Although automated background checks for healthcare employees cannot cover every possible check that may be required by state laws, some automated systems include continuous monitoring tools that alert organizations to potential issues in real time – thus reinforcing the integrity of the organization’s compliance framework. Healthcare organizations looking to reduce the administrative burden of pre-employment screening and repeat background checks for healthcare workers are advised to reach out to vendors of automated background checks for further information.
