Alabama Did Not Always Verify Selected Nursing Homes’ Compliance With Background Check Requirements

Report Materials

• Full Report(PDF, 4.0 MB)
• Report Highlights(PDF, 345.3 KB)

Why OIG Did This Audit

• Background checks for employees in long-term care facilities (nursing homes) are an important safety measure that can help protect some of the most vulnerable populations.
• Approximately 1.4 million people reside in nursing homes, with more than half of them relying on Medicaid to pay for their long-term care.
• This audit examined whether Alabama ensured that selected nursing homes complied with Federal and State requirements that prohibit the employment of individuals with disqualifying backgrounds.

What OIG Found

Alabama did not ensure, for the audit period of January 1, 2022, to April 8, 2024, that some of the nursing homes reviewed in our sample complied with Federal and State requirements that prohibit the employment of individuals with disqualifying background checks.

• Specifically, for the 439 nursing home employees we sampled, we found that for 139, the nursing homes either did not meet Federal requirements by having a background check completed before beginning work, did not meet State requirements by querying the Alabama Elderly and Adult in Need of Protective Services Abuse Registry (the Registry) before the employee began work, or a combination of both.

What OIG Recommends

We recommend that Alabama:

• develop a process for verifying that nursing homes complete a background check and a Registry query before employees begin work,
• educate nursing homes on the importance of conducting timely background checks and Registry queries,
• require nursing homes to develop policies and procedures to conduct Registry queries before employees begin work, and
• conduct a review of nursing homes' compliance with background checks and Registry check requirements.

In written comments on our draft report, the State agency agreed with our first recommendation, but neither agreed nor disagreed with the remaining recommendations. However, the State agency described actions that it has taken or will take to address all our recommendations.