The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) posted a new report on December 15, 2025, which found that New Jersey did not adequately ensure nursing homes complied with federal background check requirements designed to protect residents receiving long-term care.
The audit examined whether New Jersey ensured that selected nursing homes followed federal rules prohibiting the employment of individuals with disqualifying backgrounds during calendar year 2022. OIG reviewed 120 employees across 12 nonstatistically selected nursing homes and found that 11 of the facilities failed to fully comply with or did not document compliance with background check requirements for 33 employees.
According to the report, 9 nursing homes allowed 17 staff members to provide care before background checks were completed, 4 nursing homes employed 6 staff members without conducting background checks at all, and 1 nursing home failed to provide documentation showing that background checks were performed for the 10 employees reviewed. OIG attributed these deficiencies to insufficient employee sampling during recertification surveys and inadequate nursing home procedures for ensuring background checks were properly completed, which placed residents at risk of abuse, neglect, exploitation, or mistreatment.
OIG recommended that New Jersey improve its monitoring procedures to better ensure nursing home compliance with background check requirements and provide guidance to nursing homes on implementing adequate background check processes in accordance with federal rules. While New Jersey did not state whether it agreed or disagreed with the recommendations, it outlined steps already taken and plans to address the findings.
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, abuse-related, or exclusionary histories. Required background checks, including criminal history reviews and applicable abuse registry and exclusion list screenings, must be completed and documented before an employee begins work. Facilities should also ensure ongoing monitoring of exclusion databases, such as the OIG’s List of Excluded Individuals and Entities (LEIE), as eligibility status may change after hire due to criminal convictions or administrative actions. Failure to complete and document timely background checks and ongoing monitoring increases the risk of employing individuals who may pose a threat to resident safety and exposes facilities to regulatory enforcement, financial penalties, and reputational harm. Defined procedures and oversight can help ensure background check requirements are met.
Discussion Points
- Review and, if necessary, revise background check policies and procedures to ensure alignment with current federal and state requirements. Policies should clearly require that all background checks and any applicable registry or exclusion list queries are completed and documented prior to the start of employment. Facilities may consider working with their consultant to evaluate existing hiring workflows, identify gaps, and implement best-practice procedures that support regulatory compliance and survey readiness.
- Ensure that human resources staff and hiring managers receive regular education on background check requirements, timelines, and documentation expectations. Training should emphasize the importance of completing all required screenings before employment begins and maintaining accurate records for compliance purposes. Med-Net Academy offers the course Staying on Top of Employee Checks, which reviews key topics such as the OIG Exclusion List, the List of Debarred Contractors, licensing and certification verification, and background screening procedures.
- Conduct routine audits to verify that required background checks and exclusion screenings are consistently completed and properly documented for all employees. Facilities may benefit from engaging a third-party reviewer to perform mock audits or targeted reviews of hiring and onboarding records. This proactive approach can help identify compliance gaps early and reduce the risk of deficiencies during regulatory surveys or external audits.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*