Department of Health and Human Services 
OFFICE OF 
 
INSPECTOR GENERAL 
 
 
 
 
 
 
HO  ME HEALTH AGENCIES  
 
C B
O  NDUCTED  ACKGROUND 
 
C V T  
HE  CKS OF  ARYING  YPES 
 
 
Suzanne Murrin  
Deputy Inspector General 
for Evaluation and Inspections  
 
May 2015 
OEI-07-14-00130   
   
EXECUTIVE SUMMARY:  HOME HEALTH AGENCIES CONDUCTED 
BACKGROUND CHECKS OF VARYING TYPES  
 
WHY WE DID THIS STUDY 
 
Employees of home health agencies (HHAs) provide careusually unsupervisedto 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 the Office of Inspector General to 
analyze the extent to which HHAs employed individuals with criminal convictions and to 
explore whether these convictions should haveaccording to State requirements 
disqualified them from HHA employment.   
 
HOW WE DID THIS STUDY  
 
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.   
 
WHAT WE FOUND 
 
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 appearon the 
basis of available datato 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.  
 
WHAT WE RECOMMEND  
 
We recommend that the Centers for Medicare & Medicaid Services (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.  
   
TABLE OF CONTENTS 
 
Objectives ....................................................................................................1 

Background..................................................................................................1 

Methodology................................................................................................4 

Findings........................................................................................................6 

All HHAs conducted background checks of varying types on 

prospective employees; approximately half also conducted 

periodic checks after the date of hire ...............................................6 

Four percent of HHA employees had at least one criminal 

conviction; such convictions may or may not have disqualified 

them from employment ....................................................................7 

A review of six HHA employees with convictions for crimes  

against persons found that three have convictions that appear,  

on the basis of available data, to disqualify them from 

employment in HHAs  ....................................................................11 
 
Conclusion and Recommendation .............................................................14 

Agency Comments and Office of Inspector General Response.....................15 

Appendixes ................................................................................................16 

A: States That Received Grants From the National Background  

Check Program...............................................................................16 

B: Profile of Characteristics of Employees of Sampled Home 

Health Agencies .............................................................................17 

C: Detailed Methodology..............................................................18 

D: Point Estimates and Confidence Intervals ...............................21 

E: Agency Comments  ...................................................................24 

Acknowledgments......................................................................................25 

 
 
   
OBJECTIVES 
1. 	  To determine whether home health agencies (HHAs) conduct background 
checks on prospective and/or current employees. 
2.	   To determine the extent to which HHA  employees have criminal convictions. 
3.	   To determine whether the criminal convictions of selected employees appear 
to disqualify them for HHA employment. 
BACKGROUND 
This evaluation is in response to a congressional request for the Office of 
Inspector General (OIG) to analyze the extent to which HHAs employed 
individuals with criminal convictions and whether these convictions should have 
disqualified them from HHA employment.  This report is a companion to the 
May 2014 report entitled State Requirements for Conducting Background Checks 
on Home Health Agency Employees (OEI-07-14-00131), which identified State 
background-check requirements for HHAs and identified the types of criminal 
convictions that, under State law or regulation, disqualify individuals from HHA  
employment. 
Medicare Home Health Services 
In 2012, HHAs provided services to approximately 3.5 million Medicare 
beneficiaries, averaging 34 visits per beneficiary.  Medicare paid nearly 
$18.5 billion for HHA services that year.1  
Requirements for Conducting Background Checks 
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.2   There are also no Federal 
laws or regulations that prohibit HHAs from hiring individuals who have been 
convicted of crimes or for whom a substantiated finding concerning abuse, 
neglect, or misappropriation of beneficiary property has been entered into 
State-based registries or databases of abuse and neglect (e.g., State registries of 
____________________________________________________________ 
1 Centers for Medicare & Medicaid Services (CMS), 2013 Medicare & Medicaid Statistical  
Supplement:  Table 7.1.   Accessed at http://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/MedicareMedicaidStatSupp/Downloads/2013_Section7  
.pdf#Table7.1  on January 22,  2015.  This was the most recent data available as of March  2015.  
2 In April 2014, CMS released  guidance that it would phase in the implementation  of 
fingerprint-based background  checks for individuals  with  a 5 percent or greater ownership interest  
of a HHA newly enrolling in the Medicare program.  This action is part of the enhanced  
enrollment screening  provisions contained in P.L. No. 111-148    6401. 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  1 
   
nurse aides).3 However, as a condition of participation in Medicare, HHAs must 
comply with State laws.4  State requirements for background checks vary in terms 
of what sources of information must be checked, which job positions require 
background checks, and what types of convictions prohibit employment. 
Types of Background Checks 
In general, there are two types of background checks that States may require 
HHAs to use: statewide and Federal Bureau of Investigation (FBI).  Statewide 
background checks are typically conducted by a State law enforcement agency 
(e.g., State Highway Patrol, State Police) and include information for crimes 
committed within that State.  For an FBI background check, a State law 
enforcement agency initiates the process by providing the FBI with an 
individuals identifying information and a set of fingerprints.  The FBI checks 
them against the criminal background information maintained in its database and 
sends the results back to the State law enforcement agency.  The FBIs database  
includes information both on Federal crimes and State-reported crimes from all 
States.    
National Background Check Program 
The Patient Protection and Affordable Care Act established the Nationwide 
Program for National and State Background Checks on Direct Patient Access 
Employees of Long-Term Care Facilities and Providers (National Background 
Check Program).5  This voluntary program awards grant funds to States to 
conduct background checks on prospective long-term-care employees.  Under the 
program, prospective direct patient access employees in any of 10 provider 
types (e.g., HHAs) must undergo fingerprint-based statewide and FBI background 
checks, as well as checks of State-based registries of abuse and neglect.6 CMS 
began awarding grants to States in September 2010.  As of April 2015, CMS had 
awarded grants to 25 States, totaling more than $50 million.  A list of these States 
can be found in Appendix A. 
Related Reports 
A 2014 OIG report found that, of the 50 States and the District of Columbia 
(States), 41 States required HHAs to conduct background checks on prospective 
____________________________________________________________ 
3 State survey and certification agencies investigate allegations of abuse,  neglect, and 

misappropriation of  property  made against nurse aides.   If the States investigation concludes that
  
an allegation is valid, a substantiated finding  for the individual is entered in the States registry of 

nurse aides.  42 CFR   483.156.  Nursing facilities may not employ individuals who  have had a 

substantiated finding entered into the States registry  of nurse aides. 
  
42  CFR  483.13(c)(1)(ii)(B). 
 
4 42 CFR   484.12(a). 

5  P.L.  No. 111-148  6201. 
 
6  P.L.  No. 111-148  6201(a)(3)(A). 
 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  2 
   
employees as of January 2014.7 Of the 10 States that had no background-check 
requirement, 4 States reported that they had plans to implement 
background-check requirements. 
Thirty-five States specify convictions that disqualify individuals from  
employment, and 16 of these 35 States allow an individual who has been 
disqualified from employment to submit an application to have his/her 
disqualification waived. 
A 2012 OIG study found that 19 percent of nurse aides who received a 
substantiated finding of abuse, neglect, or misappropriation of property in 2010 
had been convicted of at least one offense prior to their substantiated finding.8   
Among these nurse aides, the most common conviction (53 percent) was for 
crimes against property (e.g., burglary, shoplifting, or writing bad checks). 
A 2011 OIG study found that 5 percent of all nursing facility employees had at 
least one criminal conviction. 9  Federal regulation prohibits Medicare and 
Medicaid nursing facilities from employing individuals found guilty by a court of 
law of abusing, neglecting, or mistreating nursing facility residents.10   The 
2011 study could not determine whether individuals with criminal convictions 
should have been disqualified from  nursing-facility employment, because 
FBI-maintained criminal history records do not indicate whether the victim of a 
crime was a nursing-facility resident.  The most common criminal conviction was 
for crimes against property.   The study recommended that CMS develop 
background check procedures by (1) clearly defining which employee 
classifications are direct patient access, and (2) working with States to develop 
a list of State and local convictions that disqualify an individual from  
nursing-facility employment under the Federal regulation and the periods for 
which each conviction bars the individual from employment.  CMS agreed with 
this recommendation. CMS convened a workgroup that produced a report listing 
options for CMS to consider in defining direct patient access employee 
classifications and developing a list of disqualifying convictions.11 
 ____________________________________________________________ 
7 OIG,  State Requirements for  Conducting Background Checks on Home Health Agency 
Employees, OEI-07-14-00131, May 2014. 

8 OIG,  Criminal Convictions for Nurse Aides  with Substantiated Findings of Abuse, Neglect, and
  
Misappropriation, OEI-07-10-00422, October 2012. 

9 OIG,  Nursing Facilities Employment of Individuals with Criminal  Convictions, 

OEI-07-09-00110, March  2011. 

10 42 CFR   483.13(c)(1)(ii)(A) 

11 CNA Corporation,  CMS,  National Background Check Program, Long Term Care Criminal 

Convictions Workgroup Report, IRM-2012-U-003468, December  2012.  

Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  3 
   
METHODOLOGY 
Sample Selection. We selected a random sample of 105 HHAs from the national 
population of 12,626 Medicare-certified HHAs that were in operation on 
January 1, 2014.  Six of the sampled HHAs were ineligible to be in our sample, 
reducing the size of the usable sample 99 HHAs.12    
Data Collection and Analysis. From the 99 sampled HHAs, we collected 
responses to a survey about background check procedures and information on all 
employees as of January 1, 2014.  The 99 HHAs reported a total of 
4,680 employees.  See Appendix B for a profile of characteristics of employees of 
the sampled HHAs.  
To gain access to information on criminal history records, we entered into an 
Information Transfer Agreement with FBI.13  We sent identifying information on 
all 4,680 HHA employees to the FBI.  We used only convictions for which we 
could conclusively match individual identifiers of the employees to those in the 
FBI database. For individuals with criminal convictions, we grouped the 
convictions into six broad categories:  crimes against persons, crimes against 
property, drug-related crimes, driving under the influence of drugs or alcohol 
(DUI), non-DUI driving-related crimes, and other crimes.14   We estimated the 
percentage of employees with each type of conviction.  See Appendix C for a 
detailed description of our methodology.  
Identification of Employees with Convictions That Appear to be Disqualifying. 
For three reasons, we could not definitively determine whether all of the sampled 
HHA employees who had criminal conviction(s) should have been disqualified 
from HHA employment.  First, not all States specify which convictions disqualify 
individuals from HHA employment.  Second, FBI criminal history information is 
not always detailed enough to determine whether a specific conviction would 
result in disqualification in the employees State.  Third, we are prohibited by the 
terms of the Information Transfer Agreement from contacting outside parties 
regarding the individuals associated with this evaluation; therefore, we could not 
collect further information to determine whether a specific conviction was  
disqualifying. 
Because we could not definitively determine whether all HHA employees with 
criminal convictions should have been disqualified from HHA employment, we 
____________________________________________________________ 
12 Although  we selected only HHAs that were listed in CMSs Certification and Survey Provider 
Enhanced Reports system as having been in  operation on January  1, 2014,  the six ineligible HHAs 
had actually closed  before that date.  
13 An Information Transfer  Agreement governs the terms of OIGs access to FBI criminal history 
records for research purposes. 

14 Convictions categorized as other crimes did not fit into  any of the other five categories.  

Examples of convictions categorized as other crimes include disturbing the peace, immigration 

violations, and  providing  false information to a police officer. 

Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  4 
   
purposively selected (1) employees whose convictions were for crimes against 
persons occurring within 5 years of their beginning employment dates, and 
(2) employees who were registered sex offenders, regardless of the dates of 
registration. These criteria are consistent with the disqualifying convictions 
established by numerous States.  
Applying the criteria described above yielded six employees who had convictions 
for crimes against persons in the last 5 years and/or were registered sex offenders.  
To determine which of the six employees had convictions that appeared, on the 
basis of available data, to disqualify them from employment in HHAs, we 
compared their convictions to the relevant State laws regarding background check 
requirements, disqualifying convictions, and waivers.  We were prohibited by the 
terms of the Information Transfer Agreement from contacting States to gather 
further information about whether the employees convictions were disqualifying; 
making such requests would have required us to disclose the employees identities 
and criminal histories. 
Limitations 
Our estimate of the number of HHA employees with criminal convictions relies 
entirely upon the accuracy of the information contained in the FBIs criminal 
history record information.  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.  
Our estimates are conservative because we did not include criminal convictions if 
we could not conclusively match the individual (e.g., if the identifiers were 
similar but did not exactly match) to a conviction record.  Also, we could not 
confirm that the employee information that HHAs provided us was accurate or 
that the information the employees provided to the HHAs was accurate. 
Standards 
This study was conducted in accordance with the Quality Standards for Inspection 
and Evaluation issued by the Council of the Inspectors General on Integrity and 
Efficiency.  
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  5 
   
FINDINGS 
All HHAs conducted background checks of varying types 
on prospective employees; approximately half also 
conducted periodic checks after the date of hire 
All HHAs reported conducting either a statewide or Federal criminal background 
check, or both. Eighty-three percent of HHAs conducted background checks on 
all prospective employees, and an additional 9 percent conducted background 
checks only on direct-care employees.15  The remaining 8 percent conducted 
background checks on a specific group of individuals, such as unlicensed 
direct-care staff.   
Seventy-two percent of HHAs did not allow employees to begin work prior to 
completion of the background check.  Of the 28 sampled HHAs that allowed 
employees to begin work pending the completion of the background check, 
9 stipulated that direct-care employees were not allowed to begin patient care 
until their background checks were complete.16   
HHAs use many different sources of information for background 
checks 
Under the National Background Check Program, prospective HHA employees 
undergo three types of background checks: checks of State databases, such as 
abuse and neglect registries; checks of statewide criminal history records; and 
checks of FBI criminal history records.17 Twenty percent of HHAs reported 
conducting these three types of checks, regardless of their respective States 
participation in the National Background Check Program.  In addition to 
statewide and FBI criminal history checks, HHAs reported checking other sources 
of information, such as the OIG List of Excluded Individuals and Entities, State 
registries of nurse aides, and State registries of sex offenders.  As one HHA 
administrator explained, Most of the background checks are very easy to do.  For 
us, the small amount of time required is well worth the peace of mind.   
____________________________________________________________ 
15 Section 6201 of the Patient Protection and Affordable Care Act uses the term direct patient 
access employees; however, the more common term used in the HHA industry is direct-care 
employees.  Therefore, we used the term direct-care employees in our survey of HHAs and  
throughout the  findings of this report.  The term direct-care employee encompasses many job 
classifications (e.g., home health aides, nurses, physical therapists).  Sampled  HHAs differed as to 
what job classifications they considered to  be direct-care jobs.   
16 Because of the relatively low number of such  HHAs in the sample, we were unable to estimate 
the percentage of all HHAs that allowed employees to  begin work  pending  the completion of  
a background check, but  did not allow employees to  begin  providing patient care until their 
background checks were complete. 
17 Only direct patient access employees are required to undergo these checks.  
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  6 
   
Over half of HHAs conducted periodic checks after the date of hire 
Fifty-eight percent of HHAs conducted periodic background checks after the date 
of hire. Of the HHAs that conducted periodic background checks, 44 percent 
conducted annual checks, and a quarter of HHAs conducted checks more 
frequently than annually.  Eleven percent of the HHAs that conducted periodic 
checks had terminated at least one employee based on the results of a periodic 
check. Table 1 shows how frequently HHAs reported conducting the periodic 
checks.  
Table 1: Frequency of Periodic Background Checks Among HHAs 
That Conducted Periodic Background Checks  
Frequency   Percentage of HHAs  
Annually  43.9%  
More frequent than annually (e.g., monthly, quarterly)   24.6%  
Less frequent than annually   15.8%  
As needed   12.3%  
Source:  OIG analysis of HHA survey responses, 2014. 
Percentages do not total 100 percent because two HHAs that reported conducting periodic 
background  checks did not answer the  question regarding  frequency.  
Four percent of HHA employees had at least one criminal 
conviction; such convictions may or may not have 
disqualified them from employment  
As of January 1, 2014, 4 percent of HHA employees had at least one conviction in 
FBI-maintained criminal history records.  Employees with at least one conviction 
in their criminal history records averaged two convictions per employee.  The 
number of criminal convictions per employee in our sample ranged from 1 to 13.   
The percentage of HHA employees who had at least one criminal conviction 
ranged by job classification from 1 percent to nearly 6 percent.  Less than 
2 percent of employees classified as either social workers/case managers or 
therapists had criminal convictions.  Table 2 shows the percentages of HHA  
employees who had a criminal conviction, by job classification. 
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  7 
   
Table 2: Percentage of HHA Employees Who Had a Criminal Conviction, 
by Job Classification  
Percentage of  
Job Classification   Employees With  
Criminal Convictions  
Home Health Aide, Certified Nurse Assistant, or other Home Care 
5.9%  
Assistant  
Administration  4.2%  
Nurse   4.1%  
Social Worker or Case Manager   1.6%  
Occupational, Physical, or Other Therapist  1.4%  
Note: One HHA employee with a conviction was listed in the  category Other Clinician.  The sample did not include 

enough HHA employees in this category to estimate the percentage of Other  Clinicians with criminal convictions in the 
 
population. 

Source:  OIG analysis of FBI criminal history records and HHA employee data, 2014. 

Of employees with convictions, 72 percent were identified as direct-care 
employees.  The term direct-care employee encompasses many job 
classifications (e.g., home health aides, nurses, physical therapists).  Sampled 
HHAs differed as to what job classifications they considered to be direct-care 
jobs. For example, some HHAs considered all job classifications (i.e., every 
employee) to be direct care.  Other HHAs considered certain job classifications, 
such as nurse manager and scheduler, not to be direct care.   
Among employees with convictions, 36 percent had at least one 
conviction for crimes against property and 12 percent had at least 
one conviction for crimes against persons 
HHA employees had convictions of many types.  Among HHA employees with 
convictions, 36 percent had at least one conviction for crimes against property.  
Crimes against property include credit card fraud, identity theft, and stealing.  
Twelve percent of HHA employees with convictions had at least one conviction 
for crimes against persons.  Crimes against persons include assault and domestic 
violence. Table 3 shows the categories of crimes for which HHA employees were 
convicted. 
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  8 
   
Table 3: Categories of Crimes for Which HHA Employees Were Convicted 
Percentage Among HHA Employees  With Criminal 
Category of Crime 
Convictions  
Crimes against property   35.8%  
Other*   26.8%  
DUI   21.1%  
Drug-related crimes  18.9%  
Driving-related crimes other than DUI   17.4%  
Crimes against persons  11.6%  
*Examples of  crimes in  the category Other include disturbing the peace, immigration violations, and providing 

false information to a police officer. 

Note:  Percentages do not sum to 100 percent because some employees had  criminal convictions in more  than 
 
one category.
  
Source:  OIG analysis of FBI criminal history records and HHA employee data, 2014.  

Most convictions occurred at least 5 years prior to employment 
Although HHA employees had convictions that occurred both before and after 
their beginning dates of employment, 66 percent of employees with criminal 
convictions had received their most recent conviction at least 5 years prior to 
employment.  For example, an individual employed since 2009 had 
13 convictions for crimes against property, the most recent of which was in 
June 1991. Nine percent of HHA employees had convictions only after beginning 
employment.  Table 4 shows the elapsed time between an employees most recent 
conviction and his or her beginning date of employment. 
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  9 
   
Table 4: Elapsed Time Between Employees Conviction and  
Beginning Date of Employment 
Percentage Among Employees 
Category of Crime  With Criminal Convictions  
Convictions before date of hire 
10 years or more before hire   43.2%  
5 years to less than 10 years before hire   22.6%  
1 year to less than 5 years before hire  19.5%  
Less than 1 year  before hire   5.3%  
Subtotal  90.5%  
Convictions after date of hire  
Less than 6 months after hire   2.1%  
6 months to 1 year after hire   1.1%  
1 year to less than 2 years after hire   2.6%  
2 years to less than 5 years after hire  0.5%  
5 years to less than 10 years after hire  2.1%  
10 years or more after hire   1.1%  
Subtotal  9.5% 
 Total   100%  
Note:  Percentages do not sum to 100 percent due to  rounding. 

Source:  OIG analysis of FBI criminal history records and HHA employee data, 2014.  

About half of HHAs employed one or more individuals with at least 
one criminal conviction 
The highest number of employees with convictions at any sampled HHA was 23; 
the total number of employees at this HHA was 280.  Table 5 shows the 
percentages of HHAs that employed various percentages of employees with 
criminal convictions.  
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  10 
   
Table 5: Percentage of HHAs That Employed Various Percentages of Employees 
With Criminal Convictions 
Percentage of Employees with Conviction(s)   Percentage of HHAs  
None   51.5%  
Up to 5.0%   23.2%  
Between 5.0% and 10.0%   16.2%  
Between 10.0%  and 15.0%    5.1%  
Between 15.0%  and 20.0%   2.0%  
Between 20.0%  and 25.0%   0.0%  
Between 25.0%  and 30.0%   0.0%  
Between 30.0%  and 35.0%   2.0% 
 Total   100%  
Source:  OIG analysis of FBI criminal history records and HHA employee data, 2014. 
A review of six HHA employees with convictions for crimes 
against persons found that three have convictions that 
appear, on the basis of available data, to disqualify them 
from employment in HHAs 
A 2014 OIG report found that, as of January 1, 2014, 41 States required HHAs to 
conduct background checks on prospective employees.  Thirty-five States 
specified convictions that disqualify employment; however, States differed in 
regard to the types of convictions that disqualify individuals from employment 
and how recently the convictions must have occurred to be disqualifying.  Sixteen 
States allowed an individual who has been disqualified from employment to 
submit an application to have his or her disqualification waived.  In reviewing the 
convictions of the six employees described below, we applied the information 
collected for the 2014 report about States background check requirements, 
disqualifying convictions, and waivers. 
Three individuals who had convictions for crimes against persons 
appearon the basis of available datato be disqualified from 
employment in HHAs; however, circumstances may have allowed 
their employment 
Three individuals who had convictions for crimes against persons appearon the 
basis of available datato have been disqualified from HHA employment.  The 
first individual was a home health aide in California and was subject to 
Californias requirement for criminal background checks for home health aides.  
This individualwho began employment in 2007had one conviction for 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  11 
   
domestic violence in November 2012.18  This employee should not have continued 
to be employed after November 2012 because she had a mandatory disqualifying 
conviction.19  The California State agency that registers home health aides 
receives notification from the State Department of Justice if individuals who are 
registered as home health aides are convicted of crimes subsequent to their initial 
registrations. California does not allow disqualifying convictions to be waived.20   
The only ways that her employment may have been appropriate is if she obtained 
a certificate of rehabilitation and/or a dismissal from the court of conviction, or if 
the criminal history record was determined to be inaccurate.21    
The second individual was a licensed vocational nurse in Texas who began 
employment in May 2013.  In Texas, a person convicted of certain offenses 
cannot be employed in direct patient access positions in long-term-care 
facilities until 5 years after the conviction.22 The individual had one conviction 
for domestic violencewhich is among Texass disqualifying offensesin 
April 2012. This individual should not have been employed, since he had a 
disqualifying conviction less than 5 years before his employment began.  Texas 
does not allow disqualifying convictions to be waived.  The only way that this 
individuals employment may have been appropriate is if his criminal history 
record was determined to be inaccurate.  The Texas Department of Public Safety 
offers disqualified individuals the opportunity to be heard if they believe that their 
criminal history records are inaccurate.23  If inaccurate information is discovered, 
the Department of Public Safety notifies the employer.   
____________________________________________________________ 
18 The individual was convicted under California Penal Code   273.5(a), willful infliction of  
corporal injury upon a spouse or cohabitant.  In accordance with California Health and Safety  
Code  1736.5(a), a conviction under California Penal Code  273.5(a) is a mandatory  
disqualifying conviction. 
19 California Health and Safety Code  1736.5(a).  
20 California has both mandatory and discretionary  disqualifying convictions.  Mandatory  
convictions require the State to  prohibit employment under California Health and Safety Code  
 1736.5(a).  Discretionary convictions may disqualify a home health aide  from employment.  
California Health and Safety  Code  1736.5(c) allows the State agency to determine whether 
certain convictions and acts listed in  1736.5(c)(1) may prohibit an individual  from being 
employed as a home health aide.  California Health and Safety Code  1736.5(c)(2) establishes 
several factors that the State agency may consider when making a determination related to  
discretionary convictions. 
21 The FBI Information Transfer Agreement prohibits us from contacting State licensing and 
certification agencies to inquire whether individuals with  disqualifying convictions met State 
requirements to  remain employed.   
22 The individual was convicted under Texas Penal Code  22.01(A(1) for assault causing bodily  
injury to a family member.  The Texas Health and Safety Code states that a person convicted of an  
offense under  Texas Penal Code  22.01 that is  punishable as a Class A misdemeanor or felony  
cannot  be employed in a position the duties of which involve direct contact with a consumer in a 
[long-term-care] facility ...before the fifth anniversary of the date the person is convicted.  Texas 
Health and Safety Code    250.006. 
23 Texas Health  and Safety Code  250.005.  
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  12 
   
The third individual had worked in administration at an Oklahoma HHA since 
December 2007.  He was registered as a sex offender in Oklahoma in 
November 2006.  Under Oklahoma law, a registered sex offender cannot be 
employed in jobs requiring direct patient access.  In Oklahoma, direct patient 
access is defined as including access to a service recipients property, medical 
information, or financial information.24  If this employees duties included access 
to patients property, medical information, or financial information, the employee 
should have been disqualified from  HHA employment.  However, we cannot 
definitively conclude that this person did have such access; it is possible that his 
specific duties did not qualify him  as a direct patient access employee.25    
Three individuals convictions did not disqualify them from HHA  
employment in their States 
Of the six individuals in our purposive sample, three had convictions for crimes 
against persons, but their convictions did not disqualify them from employment in 
their States. 
Two individuals were employed in States in which background-check 
requirements did not apply.  The first individual had been employed as a 
phlebotomist in a California HHA since October 2011 and had one conviction for 
domestic violence in 2012.26  In California, there is no State requirement for 
phlebotomists working in home health agencies to undergo criminal background 
checks.27  The second individual began employment as a certified nurse 
assistant/home health aide in Tennessee in March 2013 and was convicted of 
domestic violence that same month.  Tennessee requires that long-term-care 
employers check registry records for nurse aides, but does not require them to 
conduct statewide or FBI criminal background checks. 
The third individual was not disqualified from employment on the basis of State 
law.   The individual, employed as a certified nurse assistant in Pennsylvania since 
March 2013, had two convictions for assault and two convictions for possessing 
an instrument of crime in February 2010.  In Pennsylvania, neither assault nor 
possessing an instrument of crime are among the offenses that disqualify an 
individual from HHA employment. 
____________________________________________________________ 
24 63  Oklahoma Statutes 1-1945 through  1950. 

25 The HHA that employed this  individual  reported that he was not a direct-care employee.  

However, we believe it is likely that his job duties included  access to patients medical and 

financial information. 
 
26  A phlebotomist  is  a nurse or other health worker  trained in drawing blood.   

27 Phlebotomy training programs may require a background check.  California requires individuals 

to obtain a certificate of completion from a phlebotomy training  program in order to  be certified as 
 
a phlebotomist. 

Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  13 
   
CONCLUSION AND RECOMMENDATION 
Currently, 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.  Instead, individual State 
laws vary as to the types of employees that are required to undergo background 
checks and the frequency of periodic checks on individuals who are already 
employed.  As a result, the background checks conducted by HHAs varied as to 
which sources of information they checked.   
Because HHA employees provide careusually unsupervisedto patients in 
their homes, ensuring that HHA employees have undergone a minimum level of 
screening would help protect the safety of Medicare beneficiaries.  Overall, 
4 percent of HHA employees had at least one criminal conviction; such 
convictions may or may not have disqualified them from employment.  Our 
review of six HHA employees with convictions for crimes against persons found 
that three have convictions that appear, on the basis of available data, to disqualify 
them from employment in HHAs.  However, certain circumstances may have 
allowed employment.  The remaining three individuals convictions did not 
disqualify them from employment in their States.   
We recommend that CMS: 
Promote minimum standards in background check procedures  
The lack of Federal laws requiring background checks and the variation in State 
requirements for background checks have resulted in a lack of such checks for 
some HHA employees who provide direct, unsupervised care in patients homes.  
Ensuring a minimum level of background screening in all States would help 
ensure the safety of the HHA patient population.  CMS could promote minimum 
standards for HHA employee background checks by encouraging more States to 
participate in the National Background Check Program.  As of April 2015, CMS 
had awarded grants to 25 States, totaling more than $50 million.  This program  
requires all direct patient access employees to undergo fingerprint-based statewide 
and FBI background checks, as well as checks of State-based registries of abuse 
and neglect. In addition, the program  requires States to test methods for 
employers to automatically receive notifications of any convictions their 
employees receive following initial background checks.   
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  14 
   
AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL  
RESPONSE 
CMS concurred with the recommendation.  CMS stated that it encourages States 
to participate in the National Background Check Program, and noted that it has 
extended the deadline for responding to the ninth solicitation for grant proposals 
from States and U.S. Territories.  Grant proposals will be accepted as they are 
received, and acted on every 30 days. 
For the full text of CMSs comments, see Appendix E. 
 
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  15 
   
APPENDIX A 
Table A-1: States That Received Grants From the National Background Check 
Program 
Number  State  
1  Alaska  
2  California 
3  Connecticut 
4  Delaware  
5  District of Columbia 
6  Florida  
7  Georgia 
8  Hawaii 
9  Illinois  
10  Kentucky 
11  Maine 
12  Maryland  
13  Michigan 
14  Minnesota 
15  Missouri 
16  Nevada  
17  New Mexico 
18  North Carolina  
19  Ohio  
20  Oklahoma  
21  Oregon  
22  Puerto Rico  
23  Rhode Island  
24  Utah  
25  West Virginia  
Source:  CNA Analysis & Solutions, BGCheckInfo.  Accessed at  http://bgcheckinfo.cna.org/ on  
May 5, 2015.  
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  16 
   
APPENDIX B 
Table B-1: Profile of Characteristics of Employees of Sampled Home Health Agencies  
Number of  
Percentage of  
Characteristic  Subgroup   Employees  Employees 
(n=4,680)  
Nurse (e.g., registered and licensed practical nurses)  1,793   38.3%  
Administration  1,076  23.0%  
Home health aide, certified nurse assistant, or other 
1,048   22.4%  
home care assistant 
Occupational, physical, or other therapist  438  9.4%  
Job Classification  
Pharmacy-related classification   151  3.2%  
Social worker or  case manager   128  2.7%  
Other clinicians   29  0.6%  
Other   17  0.4%  
Female   3,932   84.0%  
Gender   Male  652  13.9%  
Not specified  96  2.1%  
30 or under   703  15.0%  
3140   1,108   23.7%  
Age on January 1, 2014   4150  1,259   26.9%  
5160   1,088   23.2%  
Over 60   522  11.2%  
White  2,292   49.0%  
Black or African American  660  14.1%  
Hispanic or Latino  317  6.8%  
Race 
Asian  235  5.0%  
Other   19  0.4%  
Not specified  1,157   24.7%  
Yes   3,540   75.6%  
Direct-Care Employee  
No  1,140   24.4%  
0 to 2 years   2,092   44.7%  
Greater than 2 years up to 5 years  1,133   24.2%  
Length of  Greater than 5 years up to 10 years  800  17.1%  
Employment on  
January 1, 2014   Greater than 10 years up to 15 years  352  7.5%  
Greater than 15 years   294  6.3%  
Not specified  9  0.2%  
Source:  OIG analysis of HHA employee data, 2014.  
 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  17 
   
APPENDIX C 
Detailed Methodology 
Data Collection 
HHA Sampling.  We selected a simple cluster sample of 105 Medicare-certified 
HHAs from the 12,626 listed in CMSs Certification and Survey Provider 
Enhanced Reports system as being in operation on January 1, 2014.  When we 
contacted nonresponding HHAs by mail and telephone, we found that 6 of these 
105 HHAs had closed before January 1, 2014.  As a result, the number of eligible 
HHAs in our sample was reduced from 105 to 99.  To project the number of 
eligible HHAs in the entire population, we used the proportion of eligible HHAs 
in our sample.  This resulted in a reduction of our eligible population from 12,626 
to an estimated 11,905 HHAs.  Our estimates of the percentages of all HHAs with 
certain characteristics apply to the estimated population of 11,905 HHAs open on 
January 1, 2014.  
Employee Data. From each of the 99 sampled HHAs, we requested information 
for all noncontract individuals who were employed on January 1, 2014.28   We  
requested each employees full name, Social Security number (SSN), date of 
birth, race, gender, beginning date of employment, and job classification.  We also 
asked whether each employee was considered a direct-care employee.29   All of the 
99 sampled HHAs responded to our data request, providing information on 
4,680 employees.  See Appendix B for a profile of characteristics of the 
employees of the sampled HHAs.  
Survey. We sent the administrator of each of the sampled HHAs a survey about 
background-check procedures. The survey included questions about the types of 
background checks the HHA conducted, the job classifications that it considered 
to be direct care, whether it allowed employees to begin working before it 
received their background-check results, and whether it conducted background 
checks on current employees.  We received completed surveys from all 99 HHAs.  
Criminal History Records. To gain access to criminal history record information, 
we entered into an Information Transfer Agreement with FBI.30   We provided the 
FBI with the employee data we obtained from HHAs.  The FBI performed a 
match based on an algorithm that considers the name, date of birth, and SSN for 
each individual.  The FBI database contains information only on individuals with 
____________________________________________________________ 
28 HHAs may contract for employees (e.g., therapists, nurses) through staffing agencies.  
Background checks on contracted employees may be conducted by staffing agencies, or they may 
be conducted  by HHAs.  To ensure that the sampled HHAsrather than  staffing agencieswould 
be the entities responsible for conducting background checks on the employees we reviewed, we 
limited  the population of employees to noncontracted employees. 
29 Sampled HHAs differed as to what job classifications they considered to be direct care. 
30 An Information Transfer  Agreement governs the terms of OIGs access to FBI criminal history 
records for research purposes. 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  18 
   
criminal history records.  This information includes charges, convictions, and case 
dispositions. 
We provided 4,680 names to the FBI, we received at least one match for 
974 individuals.31   We determined that 579 of these 974 individuals conclusively 
matched the identifiers of the individuals employed by the sampled HHAs. The 
 
identifiers of the other 395 individuals did not match the identifiers of the 
sampled HHA employees (e.g., different name, different SSN). 
The Information Transfer  Agreement that we entered into with the FBI stipulates  
that identifying information contained in FBI records shall be used only for 
research and statistical purposes.  Therefore, we were prohibited from releasing 
information that may be used to identify individuals or HHAs associated with this 
evaluation. As a result, we could not contact HHAs to further inquire about the 
background checks they conducted on the identified individuals.  Similarly, we 
could not contact State licensing and certification agencies to inquire whether 
individuals with disqualifying convictions met State requirements to remain 
employed despite those convictions.   
Analysis  
We reviewed the FBI criminal history information to identify which of the 
579 conclusively matched individuals had criminal convictions.  Of the 
579 conclusively matched individuals, 389 did not have convictions recorded in 
their criminal histories.  
Using six broad categories of offenses, we recorded the convictions in the 
criminal history of each conclusively matched individual.  We created these six 
categories after consulting  FBI definitions of crimes.32  Following are examples of 
specific offenses included in each of the six broad categories.  (These lists do not 
encompass every specific offense we included in each of the six categories.) 
	   Crimes against persons:  assault, battery, elder abuse 
	   Crimes against property:  burglary, forgery, possession of stolen property,  
theft, welfare fraud, writing bad checks 
	   Driving under the influence of drugs or alcohol 
	   Driving-related crimes (other than DUI):  careless driving, driving with a 
suspended license, failure to provide insurance 
	   Drug-related crimes:  distribution of drugs, manufacturing of drugs, 
possession of drugs or paraphernalia 
____________________________________________________________ 
31  FBI did  not provide any  matches for 3,706  individuals;  therefore, we did not perform  further  
analysis on these individuals. 

32  FBI,  Crimes Against  Persons, Property, and Society.  Accessed at http://www.fbi.gov/about-
us/cjis/ucr/nibrs/2011/resources/crimes-against-persons-property-and-society  on August 1, 2014. 

Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  19 
   
 	  Other: disturbing the peace, immigration violations, providing false 
information to a police officer 
We estimated the percentages of HHA employees who had each type of 
conviction. Appendix D contains the confidence intervals for all point estimates 
in the report. 
Scope 
We did not measure any effects that States participation in the National 
Background Check Program might have had on background-check requirements 
or on the number of employees with convictions. 
We did not determine whether differing State background check requirements had 
an effect on the number of individuals with convictions employed in HHAs. 
We did not collect information from HHAs on the number of prospective 
employees whom they did not hire because of disqualifying criminal convictions.  
HHAs are not required to collect or maintain this type of information.   
 
   
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  20 
   
APPENDIX D 
 
Table D-1: Point Estimates and Confidence Intervals  
95-Percent 
Number of   Point 
Estimate Characteristic   Confidence  
Observations   Estimate  
Interval  
Estimates  of  HHAs conducting background  checks on employees  
Percentage of HHAs that conducted background checks  99  100%   87.8%100%  
Percentage of HHAs that conducted background checks on all prospective employees  99  82.8%  74.0%89.1%  
Percentage of HHAs that conducted background checks only on direct-care 
99  9.1%   4.8%16.7%  
employees  
Percentage of HHAs that conducted background checks only on a  specific group of 
99  8.1%   4.1%15.5%  
individuals 
Estimates of HHAs  allowing employees to work prior to completion of background check  
Percentage of HHAs that did not allow employees to work prior to completion of 
99  71.7%   62.0%79.8%  
background check 
Percentage of HHAs that allowed employees to work prior to completion of 
99  28.3%   20.2%38.0%  
background check 
Estimates of HHAs  conducting State database checks, statewide criminal history  checks, and FBI criminal history checks  
Percentage of HHAs that conducted State database checks, statewide criminal history  
99   20.2%  13.3%29.4%  
checks, and FBI criminal history checks  
Estimates  of HHAs conducting periodic background checks at  various frequencies 
Percentage of HHAs that conducted periodic background checks  99  57.6%   47.5%67.0%  
Percentage of HHAs that terminated employees on the basis of periodic background 
57  10.5%   4.8%21.7%  
checks  
Percentage of HHAs that conducted periodic background checks annually   57  43.9%   31.5%57.0%  
Percentage of HHAs that conducted periodic background checks more frequently than 
57  24.6%   15.0%37.5%  
annually  
Percentage of HHAs that conducted periodic background checks less frequently than  
57  15.8%   8.4%27.8%  
annually  
Percentage of HHAs that conducted periodic background checks as needed  57  12.3%   5.9%23.8%  
Estimates  of HHA  employees with one or more convictions*  
Percentage of HHA employees with at least one conviction   4,680  4.1%   3.1%5.4%  
Average number of convictions per HHA employees with at least one conviction   4,680   2.0%   1.7%2.2%  
Percentage of home health aides, certified nurse assistants, or other home care 
1,048  5.9%   4.1%8.5%  
assistants with convictions 
Percentage of administrative staff with convictions  1,076  4.2%   2.8%6.2%  
Percentage of nurses with convictions  1,793  4.1%   2.8%5.9%  
Percentage of social workers or case managers with convictions  128  1.6%   0.3%8.2%  
Percentage of occupational, physical, or other therapists with convictions  438  1.4%   0.6%3.0%  
*One HHA employee with a conviction was listed in  the category  Other Clinician.  The sample did not have enough  HHA employees  in this category  to 
estimate the percentage of Other Clinicians with criminal convictions in the population. 
continued on next page  
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  21 
   
Table D-1: Point Estimates and Confidence Intervals (continued)  
95-Percent 
Number of   Point 
Estimate Characteristic   Confidence  
Observations   Estimate  
Interval  
Estimates  of HHA  employees with one or more convictions  (continued) 
Percentage of direct-care staff with convictions  190  72.1%   56.3%83.9%  
Estimates of  HHA  employees with  various types  of  convictions  
Percentage of HHA employees with convictions for crimes against property   190  35.8%   29.7%42.3%  
Percentage of HHA employees with convictions for other crimes (e.g., disturbing the 
190  26.8%   21.5%33.0%  
peace, immigration violations, providing false information to a police officer)  
Percentage of HHA employees with convictions for DUI   190  21.1%   15.1%28.5%  
Percentage of HHA employees with convictions for drug-related crimes  190  18.9%   12.7%27.3%  
Percentage of HHA employees with convictions for driving-related crimes other than  
190  17.4%   12.2%24.2%  
DUI  
Percentage of HHA employees with convictions for crimes against persons  190  11.6%   8.4%15.8%  
Estimates of  elapsed  time  between  HHA  employees dates of conviction and beginning dates of employment  
Percentage of HHA employees with convictions who had convictions only  after their  
190  9.5%   6.0%14.7%  
beginning dates of employment  
Estimates of employees who had convictions before  their  dates  of  hire  
Percentage of HHA employees whose most recent conviction was more than 
190   43.2%  34.4%52.4%  
10 years before their dates of hire  
Percentage of HHA employees whose most recent conviction was more than 5  years 
190  22.6%   16.2%30.7%  
but less than 10 years before their dates of hire  
Percentage of HHA employees whose most recent conviction was more than 1  year  
190  19.5%   13.8%26.8%  
but less than 5 years before their dates of hire  
Percentage of HHA employees whose most recent conviction was less than 1 year  
190  5.3%   2.6%10.4%  
before their dates of hire 
Percentage of HHA employees with convictions who had convictions before their 
190  90.5%   85.3%94.0%  
dates of hire  
Estimates of employees who had convictions after their  dates  of  hire  
Percentage of HHA employees whose most recent conviction was less than 6 months  
190   2.1%  0.9%4.7%  
after their dates of hire  
Percentage of HHA employees whose most recent conviction was more than 
190   1.1%  0.3%4.0%  
6 months but less than 1 year after their dates of hire 
Percentage of HHA employees whose most recent conviction was more than 1  year  
190   2.6%  1.1%6.4%  
but less than 2 years after their dates of hire  
Percentage of HHA employees whose most recent conviction was more than 2  years 
190   0.5%  0.1%3.6%  
but less than 5 years after their dates of hire  
Percentage of HHA employees whose most recent conviction was more than 5  years 
190   2.1%  0.8%5.2%  
but less than 10 years after their dates of hire  
Percentage of HHA employees whose most recent conviction was more than 
190   1.1%  0.3%4.2%  
10 years after their dates of hire  
continued on next page  
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  22 
   
Table D-1: Point Estimates and Confidence Intervals (continued)  
95-Percent 
Number of   Point 
Estimate Characteristic   Confidence  
Observations   Estimate  
Interval  
Estimates  of  HHAs at which certain percentages of employees have convictions  
Percentage of HHAs at  which  no employees have  convictions   99  51.5%   41.6%61.3%  
Percentage of HHAs  at  which  up to 5 percent of employees have  convictions  99  23.2%   15.9%32.7%  
Percentage of HHAs at  which  more than 5 and up to 10 percent of employees have 
99  16.2%   10.1%24.9%  
convictions 
Percentage of HHAs at  which more than 10 and up to 15 percent of employees have 
99  5.1%   2.1%11.7%  
convictions 
Percentage of HHAs at  which more than 15 and up to 20 percent of employees have 
99  2.0%   0.5%7.8%  
convictions 
Percentage of HHAs at  which more than 20 and up to 25 percent of employees have 
99  0.0%   0.0%3.7%  
convictions 
Percentage of HHAs at  which more than 25 and up to 30 percent of employees have 
99  0.0%   0.0%3.7%  
convictions 
Percentage of HHAs at  which more than 30 and up to 35 percent of employees have 
99  2.0%   0.5%7.8%  
convictions 
Source:  OIG analysis of FBI criminal history records, HHA employee data,  and HHA survey responses, 2014.  
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  23 
  APPENDIX E 
Agency Comments 
DEPARTMENT OF HEALTH & HUMAN SERVICES  Centers for Medicare & Medicaid Services 
------- -----
APR 30  2015  200 Independence Avenue SW 
Washington, DC 20201 
To: 	 Daniel R. Levinson 
Inspector General 
Office of the Inspector General 
From: 	 Andrew M. Slavitt 
Acting Administrator 
Centers for Medicare & Medicaid Services 
Subject: 	 Home Health Agencies' Employment ofindividuals with Criminal Convictions 
(OEI-07-I4-00 I30) 
The Centers for Medicare & Medicaid Services (CMS) appreciates the opportunity to review and 
comment on the Office of the Inspector General's (OIG) draft report. CMS is committed to 
ensuring Medicare and Medicaid beneficiaries receive high quality health care. 
Currently, CMS is sponsoring the National Background Check Program (NBCP), a national 
program to identify efficient, effective, and economical procedures for long term care facilities 
and providers to conduct background checks on a statewide basis for all potential direct patient 
access employees. To date, CMS has awarded nearly $57 million to 25 States and U.S. 
Tenitories so that they may design comprehensive national background check programs. Two 
States, Delaware and Illinois, have graduated from the program. Delaware graduated from the 
program in September 2013 and with the use of grant funds expanded the breadth of provider 
types and transformed a paper-based, labor-intensive background check system into a fully 
automated system. lllinois graduated from the program in December 2014 and also used grant 
funds to modemize their background check computer system. This updated system interfaces 
with other agencies, including the lllinois State Police. Additionally, an internet-based training 
program was developed to educate providers on the usc.ofthe background check system. 
OIG Recommendation 
The OlG recommends that CMS promote minimum standards in background check procedures. 
The CMS concurs with this recommendation. CMS encourages States and U.S. Territories to 
participate in the National Background Check Program (NBCP). The deadline for responding to 
the ninth solicitation for grant proposals from States and U.S. TetTitories for inclusion in this 
National Back!,>round Check Program deadline has been extended and applications will be 
accepted on a flow basis and acted on every 30 days. 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  24   
 
ACKNOWLEDGMENTS 
This report was prepared under the direction of Brian T.  Whitley, Regional 
Inspector General for Evaluation and Inspections in the Kansas City regional 
office.  
Tricia Fields served as the team leader for this study.  Other Office of Evaluation 
and Inspections staff from the Kansas City regional office who conducted the 
study include Michael Brown, Conswelia McCourt, and Michala Walker.  Central 
office staff who provided support include Clarence Arnold, Heather Barton, 
Berivan Demir Neubert, Scott Manley, and Christine Moritz.  
 
Home Health Agencies Conducted Background Checks of Varying Types (OEI-07-14-00130)  25 
   
Office of Inspector General
http://oig.hhs.gov  
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as  
amended, is  to protect the integrity of the Department of  Health and Human Services  
(HHS)  programs, as well as the health and welfare of beneficiaries  served by those 
programs.  This statutory mission  is  carried  out through  a nationwide network  of  audits, 
investigations, and inspections conducted by the  following operating components: 
Office of Audit Services 
The Office  of  Audit Services  (OAS) provides auditing services  for HHS, either by  conducting  
audits  with its own audit resources or by  overseeing  audit work done by others.  Audits  
examine the performance of HHS programs and/or its grantees and contractors in carrying  
out their respective responsibilities and are intended  to provide independent assessments of 
HHS programs and operations.  These assessments help reduce waste, abuse, and  
mismanagement and promote economy and efficiency  throughout  HHS. 
Office of Evaluation and Inspections 
The Office  of  Evaluation and Inspections (OEI)  conducts national evaluations to  provide 
HHS, Congress, and the public with timely, useful, and reliable information on significant 
issues.  These evaluations focus on preventing fraud,  waste, or abuse  and promoting  
economy, efficiency, and effectiveness of departmental programs.  To promote impact, OEI 
reports also present practical recommendations for improving program operations.  
Office of Investigations 
The Office of Investigations (OI) conducts criminal, civil, and administrative investigations  
of  fraud and misconduct  related to HHS programs, operations, and beneficiaries.  With 
investigators working in all 50 States and the District of Columbia, OI  utilizes its resources 
by actively  coordinating with the Department  of Justice  and other Federal, State, and local 
law enforcement authorities.  The investigative efforts of OI often lead to  criminal 
convictions, administrative sanctions,  and/or  civil monetary  penalties.  
Office of Counsel to the Inspector General 
The Office of Counsel to the  Inspector  General (OCIG) provides general legal services to 
OIG, rendering  advice and opinions on HHS programs and operations and  providing all  
legal support for OIGs  internal operations.  OCIG represents  OIG in all civil and 
administrative fraud and abuse cases involving HHS programs,  including False Claims Act, 
program exclusion, and civil monetary penalty cases.  In  connection with these cases, OCIG 
also negotiates and monitors corporate integrity agreements.  OCIG renders advisory 
opinions, issues compliance program  guidance, publishes fraud alerts, and provides other  
guidance  to  the health care industry concerning the anti-kickback statute and other  OIG  
enforcement authorities.