In May 2015, the U.S. Office of Inspector General (OIG) released the report, “Home Health Agencies Conducted Background Checks of Varying Types,” which contains key considerations for a sector of the healthcare industry that provides care, often unsupervised, to patients in their homes. While there are currently no federal laws requiring home health agencies to conduct pre-employment background checks, a 2014 report found that 41 states require home health agencies to conduct background checks on employees as of January 1, 2014. The OIG’s current study analyzed the extent to which home health agencies employed individuals with criminal convictions and “to explore whether these convictions should have—according to State requirements—disqualified them from [employment].”

Here’s what you need to know about the OIG’s findings and their recommendations.

Home Health Agency Background Check Trends

The OIG found that home health agencies conduct background checks of varying types on prospective employees, while approximately half also conducted periodic checks after time of hire. For home health agencies, ongoing background screening remains key as states such as Ohio require post-hire background checks. Additionally, in a Special Advisory Bulletin issued in 2013, the OIG established monthly exclusion screening as the standard in the healthcare, as it minimizes the level of risk.

Home Health Agency Employees with Criminal Convictions

Of the sample analyzed in the study, four percent of home health agency employees had at least one criminal conviction. Of the six selected home health agency employees with criminal convictions that the OIG conducted a more indepth review, three had convictions for crimes against persons that appear, based on the available data, to disqualify from employment. The remaining three individuals’ convictions did not disqualify them from employment in their respective States.

The OIG Calls for Background Check Standards

Based on the results of the study, the OIG recommends that the Centers for Medicare & Medicaid Services (CMS) promote background check standards. “CMS could promote minimum standards for [home health agency] employee background checks by encouraging more States to participate in the National Background Check Program,” the OIG concluded.  

While I applaud the OIG’s recommendation for the promotion of background check standards, the National Background Check Program is flawed because it relies on the FBI’s fingerprint database. There are many flaws with the FBI’s criminal history data, which is why the National Background Check Program is not an effective background screening program.

FBI Criminal History Data is Insufficient

In the report, the OIG recognized that FBI criminal history records were not detailed enough to enable them to “definitively determine whether employees with criminal convictions should have been disqualified from employment.”

“Because the FBI relies on local, State, and Federal law enforcement agencies to report criminal records, it is possible that not all criminal history record information was accurate and up to date,” the OIG explained.

It’s interesting how the OIG recognized the incompleteness of the FBI’s criminal history data, yet ultimately recommended its use through the National Background Check Program. Background check experts, however, don’t recommend the reliance on the FBI background check in employment screening because the data is simply of poor quality and accuracy.

In a December 2014 article published on Roll Call, Melissa Sorenson, Executive Director of the National Association of Professional Background Screeners (NAPBS), commented on the inaccuracy of the FBI’s criminal records. “The FBI database is far from perfect and should never be regarded as the most reliable source for comprehensive and accurate background screening,” Sorenson stated in the article.

Sorenson’s criticism of the FBI database is based, partly, on previous studies questioning the quality of its data. A 2006 Attorney General’s report on Criminal History Background Checks estimated that “final disposition information for approximately 50 percent of [FBI] records” is missing.

While I agree with the OIG’s recommendation that minimum standards for background check procedures are necessary, the National Background Check Program is severely flawed by design. By contrast, an effective background check program would include primary source criminal searches. In other words, this means going directly to the local county and state records that may or may not be reported to the FBI’s database. A background check is only as strong as the quality and accuracy of its sources. Therefore, home health agencies and other healthcare employers should take caution from relying too heavily on the FBI background check.

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