- The Washington Times - Sunday, June 1, 2014

Home health care workers, who have become an essential part of the treatment network for the elderly and homebound, are escaping background checks in at least 10 states in what federal investigators warn is potential security hole.

The Health and Human Services inspector general reports there is no federal requirement for criminal background checks for home health workers, but that 40 states do offer some form of vetting, But convicts can become home health care providers in Alabama, Connecticut, Georgia, Hawaii, Montana, New Jersey, North Dakota, South Dakota, West Virginia, and Wyoming, investigators found.

“Beneficiaries receiving care from HHAs (home health agencies) are especially at risk of mistreatment because employees are providing services, usually unsupervised, in beneficiaries’ homes. However, 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 an individual has been hired,” the watchdog report reads.

According to the Inspector General’s report, HHAs provided services to approximately 3.5 million Medicare beneficiaries, averaging 34 visits per beneficiary in 2012. Medicare paid nearly $18.5 billion for HHA services that year.


Of the states that have no background check requirements, four (Connecticut, Georgia, Hawaii, and West Virginia) reported that they have plans to implement record checking requirements in the future.

While the other 40 states, and the District of Columbia, do require varying levels of checks, only 15 require the employment agency to receive and confirm the results of the check before an individual can begin working with patients.

Another 20 states allow individuals to work with patient for a specified timeframe while background checks are conducted. For example, Indiana requires that the background check be initiated within three days of providing care for a client and completed within 21 days of hire, according to the IG.

In 16 states, individuals who were denied home health care employment due to criminal violation can submit applications to have the conviction waived, depending on the severity of the crime and the circumstances of the arrest.

A spokesman for the Service Employees International Union (SEIU) told The Washington Times that they believe states should run background checks on all direct care workers, “to ensure that individuals with a history of violence or financial malfeasance do not participate in the Medicaid program as a provider.”

SEIU also recommended that the states fund the checks, which should include FBI database searches and should be done so quickly without any cost to the caregiver.

The union did agree that caregivers should be allowed to work provisionally pending the results of a background check, but said that agencies should carefully consider which crimes should be determined as disqualifying.