Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

HOME HEALTH AGENCIES 

CONDUCTED BACKGROUND 

CHECKS OF VARYING TYPES 

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 care—usually unsupervised—to 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 have—according 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 appear—on the 

basis of available data—to 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-andSystems/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 

individual’s 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 FBI’s 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 State’s investigation concludes that
 

an allegation is valid, a substantiated finding for the individual is entered in the State’s registry of 

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

substantiated finding entered into the State’s 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. 

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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 employee’s 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 CMS’s 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 OIG’s 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 FBI’s 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 

Job Classification 

Percentage of 

Employees With 

Criminal Convictions 

Home Health Aide, Certified Nurse Assistant, or other Home Care 

Assistant 

5.9% 

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 

Category of Crime Percentage Among HHA Employees With Criminal 

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 employee’s 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 Employee’s Conviction and 

Beginning Date of Employment 

Category of Crime Percentage Among Employees 

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 

appear—on the basis of available data—to be disqualified from 

employment in HHAs; however, circumstances may have allowed 

their employment 

Three individuals who had convictions for crimes against persons appear—on the 

basis of available data—to have been disqualified from HHA employment. The 

first individual was a home health aide in California and was subject to 

California’s requirement for criminal background checks for home health aides. 

This individual—who began employment in 2007—had 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 violence—which is among Texas’s disqualifying offenses—in 

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 

individual’s 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 recipient’s property, medical 

information, or financial information.”24 If this employee’s 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 care—usually unsupervised—to 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 CMS’s 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 

Characteristic Subgroup 

Number of 

Employees 

(n=4,680) 

Percentage of 

Employees 

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 

home care assistant 1,048 22.4% 

Job Classification Occupational, physical, or other therapist 438 9.4% 

Pharmacy-related classification 151 3.2% 

Social worker or case manager 128 2.7% 

Other clinicians 29 0.6% 

Other 17 0.4% 

Gender 

Female 

Male 

Not specified 

3,932 

652 

96 

84.0% 

13.9% 

2.1% 

30 or under 703 15.0% 

31–40 1,108 23.7% 

Age on January 1, 2014 41–50 1,259 26.9% 

51–60 1,088 23.2% 

Over 60 522 11.2% 

White 2,292 49.0% 

Black or African American 660 14.1% 

Race 

Hispanic or Latino 317 6.8% 

Asian 235 5.0% 

Other 19 0.4% 

Not specified 1,157 24.7% 

Direct-Care Employee 

Yes 

No 

3,540 

1,140 

75.6% 

24.4% 

Length of 

Employment on 

January 1, 2014 

0 to 2 years 

Greater than 2 years up to 5 years 

2,092 

1,133 

44.7% 

24.2% 

Greater than 5 years up to 10 years 

Greater than 10 years up to 15 years 

800 

352 

17.1% 

7.5% 

Greater than 15 years 

Not specified 

294 

9 

6.3% 

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 CMS’s 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 employee’s 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 HHAs—rather than staffing agencies—would 

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 OIG’s 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/aboutus/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 

Estimate Characteristic Number of 

Observations 

Point 

Estimate 

95-Percent 

Confidence 

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 

employees 99 9.1% 4.8%–16.7% 

Percentage of HHAs that conducted background checks only on a specific group of 

individuals 99 8.1% 4.1%–15.5% 

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 

background check 99 71.7% 62.0%–79.8% 

Percentage of HHAs that allowed employees to work prior to completion of 

background check 99 28.3% 20.2%–38.0% 

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 

checks, and FBI criminal history checks 99 20.2% 13.3%–29.4% 

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 

checks 

57 10.5% 4.8%–21.7% 

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 

annually 57 24.6% 15.0%–37.5% 

Percentage of HHAs that conducted periodic background checks less frequently than 

annually 57 15.8% 8.4%–27.8% 

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 

assistants with convictions 1,048 5.9% 4.1%–8.5% 

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) 

Estimate Characteristic Number of 

Observations 

Point 

Estimate 

95-Percent 

Confidence 

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 

peace, immigration violations, providing false information to a police officer) 190 26.8% 21.5%–33.0% 

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 

DUI 190 17.4% 12.2%–24.2% 

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 

beginning dates of employment 190 9.5% 6.0%–14.7% 

Estimates of employees who had convictions before their dates of hire 

Percentage of HHA employees whose most recent conviction was more than 

10 years before their dates of hire 190 43.2% 34.4%–52.4% 

Percentage of HHA employees whose most recent conviction was more than 5 years 

but less than 10 years before their dates of hire 190 22.6% 16.2%–30.7% 

Percentage of HHA employees whose most recent conviction was more than 1 year 

but less than 5 years before their dates of hire 190 19.5% 13.8%–26.8% 

Percentage of HHA employees whose most recent conviction was less than 1 year 

before their dates of hire 190 5.3% 2.6%–10.4% 

Percentage of HHA employees with convictions who had convictions before their 

dates of hire 190 90.5% 85.3%–94.0% 

Estimates of employees who had convictions after their dates of hire 

Percentage of HHA employees whose most recent conviction was less than 6 months 

after their dates of hire 190 2.1% 0.9%–4.7% 

Percentage of HHA employees whose most recent conviction was more than 

6 months but less than 1 year after their dates of hire 190 1.1% 0.3%–4.0% 

Percentage of HHA employees whose most recent conviction was more than 1 year 

but less than 2 years after their dates of hire 190 2.6% 1.1%–6.4% 

Percentage of HHA employees whose most recent conviction was more than 2 years 

but less than 5 years after their dates of hire 190 0.5% 0.1%–3.6% 

Percentage of HHA employees whose most recent conviction was more than 5 years 

but less than 10 years after their dates of hire 190 2.1% 0.8%–5.2% 

Percentage of HHA employees whose most recent conviction was more than 

10 years after their dates of hire 190 1.1% 0.3%–4.2% 

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) 

Estimate Characteristic Number of 

Observations 

Point 

Estimate 

95-Percent 

Confidence 

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 

convictions 

99 16.2% 10.1%–24.9% 

Percentage of HHAs at which more than 10 and up to 15 percent of employees have 

convictions 

99 5.1% 2.1%–11.7% 

Percentage of HHAs at which more than 15 and up to 20 percent of employees have 

convictions 

99 2.0% 0.5%–7.8% 

Percentage of HHAs at which more than 20 and up to 25 percent of employees have 

convictions 

99 0.0% 0.0%–3.7% 

Percentage of HHAs at which more than 25 and up to 30 percent of employees have 

convictions 

99 0.0% 0.0%–3.7% 

Percentage of HHAs at which more than 30 and up to 35 percent of employees have 

convictions 

99 2.0% 0.5%–7.8% 

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 3 0 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. 

Ten·itories 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 OIG’s 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.