The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) posted a new report on August 14, 2025, which found that some nursing homes in Alabama did not consistently comply with federal and state background check requirements intended to protect vulnerable residents.
The audit, covering the period from January 1, 2022, to April 8, 2024, reviewed whether the Alabama Department of Public Health ensured that selected nursing homes conducted required background checks and queries of the Alabama Elderly and Adult in Need of Protective Services Abuse Registry (the Registry) before employees began work. Among 439 nursing home employees sampled, 139 lacked one or both of these required checks.
Federal regulations prohibit nursing homes from employing individuals with disqualifying offenses, such as abuse or neglect of residents, and while these rules do not explicitly require background checks, they implicitly mandate thorough investigations of employee histories. The report recommends that Alabama develop verification processes, educate nursing homes on timely background checks and Registry queries, require policies to support these efforts, and conduct ongoing compliance reviews.
In response, the Alabama Department of Public Health agreed with the recommendation to develop verification processes and described actions taken or planned to address all recommendations, although it neither agreed nor disagreed with the others.
The full report can be accessed here.
Compliance Perspective
Issue
Federal and state regulations prohibit long-term care facilities from employing individuals with disqualifying criminal or abuse-related histories. Comprehensive background checks—including checks of state abuse registries and federal databases—must be completed before an employee begins work. In particular, facilities should verify that prospective employees are not listed on the OIG’s List of Excluded Individuals and Entities (LEIE) or other exclusion lists. After hire, it is essential that government databases such as the LEIE continue to be monitored on a regular basis, as employees may become ineligible due to criminal convictions or administrative actions that occur after their initial screening. Failing to conduct timely and ongoing checks increases the risk of employing individuals who may pose a threat to residents and exposes the facility to regulatory action, civil penalties, and reputational harm. Facilities must establish robust systems to verify and document compliance with these requirements.
Discussion Points
- Review and, if necessary, revise your background check policies to ensure they align with both federal and state requirements. Policies should clearly state that background checks and any required abuse registry queries must be completed and documented before employment begins. Facilities may benefit from working with a consultant to assess current hiring procedures, strengthen compliance infrastructure, and implement best-practice policies based on guidance from the Centers for Medicare & Medicaid Services (CMS) and recent audit findings.
- Train HR personnel and hiring managers on the importance of timely, compliant background checks and registry queries. Staff should understand both what is required and when it must be completed. Reinforce the importance of proper documentation and recordkeeping to support audit readiness. Med-Net Academy offers the course Staying on Top of Employee Checks, which covers essential topics such as the OIG Exclusion List, the List of Debarred Contractors, licensing and certification verification, and background screening procedures.
- Conduct periodic internal audits to confirm that all required pre-employment checks and registry queries are completed and properly documented. Facilities should consider engaging a third-party resource to perform targeted mock audits or reviews of hiring and onboarding practices. This proactive approach can help identify gaps before they lead to survey citations or compliance issues.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*