Home Healthcare Background Check ABCs

October 15, 2021

By a Biometrica staffer

A paper published in 1999 stated, in very simple terms, that fraudulent and abusive practices in the home healthcare space are costly. They damage the integrity of the home health agency, the home care industry, and home care providers, it added. And, of course, they can collectively lead to billions of dollars in fines and settlements. It could be something that’s common like healthcare fraud and Medicare or Medicaid fraud. Last December, for instance, during the year of the Covid-19 pandemic, ten people were arrested in a widespread healthcare fraud scheme to falsely bill Medicaid for home-health and personal-care services that were not actually rendered. 

Then, there are much darker examples that serve to show why it is important to prevent crimes, whether frauds or abuse, in the healthcare industry. For example, in 2018, a former nurse at a long-term care facility sexually assaulted an incapacitated patient under his care who gave birth to a child later that year. The pregnancy was discovered by an employee at the Hacienda Healthcare facility in Phoenix, Arizona only when the woman was in the process of delivering the child. The surprise birth triggered reviews by state agencies, highlighted safety concerns for patients who are severely disabled or incapacitated and prompted the resignations of Hacienda’s chief executive and one of the victim’s doctors, the Associated Press said in its report on the ex-nurse, Nathan Sutherland, entering a guilty plea to charges related to the case.

It is critical to hire the right person for the job when it comes to healthcare providers who work at someone’s home or at long-term care facilities. These professionals are most likely being hired to take care of some of the most vulnerable individuals in society — from those who are incapacitated, to those with developmental needs, to those with disabilities, including children, and the elderly. Home healthcare providers, especially, also have access to spaces where everyone is at their most relaxed and vulnerable, and that makes hiring decisions even more important.

While there are several qualifications that one looks for when it comes to hiring home healthcare providers, this piece is concerned about only one aspect: making sure you don’t hire someone with a criminal background that would make them unsuitable for the job. On the other hand, home healthcare providers have also faced abuse at the hands of their clients or their clients’ families. From both perspectives, then, how do you ensure you know who you’re hiring or who you are working for? One simple step is to conduct a background check. In the rest of this piece, we give you a quick overview of what that could look like from a prospective employer’s perspective.

For example, let’s say you decide to go with a Home Health Agency (HHA) to hire a home nurse. HHAs are not mandated to run a background check on their caregivers by law. But those that want to receive Medicare or Medicaid funding have to comply with state laws governing home healthcare background checks based on regulations framed by the Centers for Medicare/Medicaid Services (CMS).

Per the National Background Check Program, states are given grants to create a standardized system for conducting background checks of home healthcare providers who will be in direct contact with patients. But the participation by states is voluntary, which means not all states have done so. Nevertheless, each state has its own requirements for HHA home healthcare provider background checks.

If we take New York, for example, the Department of Health (DOH) runs a criminal background check on most home health aides and certified nurse aides in the state. According to a Legal Aid article, once an employer wants to hire a home health aide or any other kind of healthcare provider in New York, the employer is required to submit an electronic background check request through the Criminal History Record Check (CHRC) system of the DOH.

The DOH, in turn, will request the Federal Bureau of Investigation (FBI) for the particular individual’s criminal record. Once the DOH receives the record, it will determine whether or not an individual is eligible for employment and then send a letter to the prospective employer. Some of the types of letters they may send include a no-hit letter, a non-denial, not held in abeyance, held in abeyance, pending denial, and final denial.

A no-hit letter, like the name suggests, means the individual has been cleared and approved to work per the DOH as they don’t have any pending arrests and no criminal convictions, or all their arrests and convictions have been sealed. A non-denial letter is when an individual has at least one criminal conviction but the DOH determines that the conviction shouldn’t prevent them from working as a home healthcare provider. The letter implies that the DOH has approved the individual, but the convictions will be listed and the employer must take the final hiring decision.

It is illegal for the employer to deny an individual a job based on their conviction record, unless there is a direct relationship between the record and the job. In other words, unless the record indicates that the individual would pose a risk to people or property if they were hired for the job, it would be illegal to deny them that position.

Similarly, a “not held in abeyance” letter would mean that an individual has open charges but that the DOH has determined it should not prevent them from working as a home healthcare provider. As with the non-denial letter, the charges will be listed by the DOH and the final hiring decision lies with the prospective employer. “Held in abeyance,” in contrast, means that the DOH thinks an individual’s open charges could prevent them from being eligible for employment as a home healthcare provider. It would mean the person is prohibited by the DOH from providing direct care to patients until the criminal case is resolved and DOH makes a final determination of eligibility for employment.

Pending denial is when an individual has at least one criminal conviction and DOH is considering denying their eligibility for employment. As with the previous one, it means the person is prohibited by the DOH from providing direct care to patients. The individual will have 30 days to submit information to the DOH, before the DOH makes a final determination. Final denial, as the name suggests, means the DOH has determined an individual ineligible for employment. They will be unable to work if this type of letter is sent to their agency.