Criminal background checks, which CDIA members conduct, help keep people and property safe where they live and work. Employers, landlords, nonprofits, charities, religious institutions, and government agencies often conduct criminal background checks to protect the public. The latest example of this comes from the U.S. Department of Health and Human Services (HHS).
In July 2023, HHS proposed additional criminal background checks for hospices. The Department found increases in “potential and actual criminal behavior, fraud schemes, and improper billing.” The Department added that
Although not every case of hospice fraud involves or can be attributable to the hospice’s owner, we believe the owner can set the tone for the hospice’s operations as a whole. If, accordingly, an owner has a criminal background involving fraud or patient abuse, this could lead to similar activity within the hospice. We believe that the increasing number of fraud cases warrants a revisiting of our original assignment of hospices to the moderate risk category. With our obligation to protect the Trust Funds and vulnerable Medicare beneficiaries, we believe more thorough scrutiny of hospice owners is required.
The new criminal background check requirements add to those already in place. Under the hospice conditions of participation: (1) the hospice must obtain a criminal background check on all hospice employees who have direct patient contact or access to patient records; and (2) hospice contracts must require that all contracted entities obtain criminal background checks on contracted employees who have direct patient contact or access to patient records.
Sadly, criminal behavior, fraud schemes, and improper billing in health care is big business. For example, in HHS’ Medicaid Fraud Control Units Fiscal Year 2022 Annual Report, it found 946 instance of fraud and 381 cases of patient neglect or abuse, resulting in 1,327 convictions and 1,018 people banned from receiving future federally funded health care programs.
Eric J. Ellman is Senior Vice President for Public Policy and Legal Affairs at the Consumer Data Industry Association (CDIA) in Washington, DC. He also served for eight months as Interim President and CEO of the Association. More