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

Issued on  | Posted on  | Report number: A-04-24-08104

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.

25-A-04-093.01 to CMS - Open Unimplemented
Update expected on 02/11/2026
We recommend that the Alabama Department of Public Health develop a process for verifying that nursing homes complete a background check and a Registry query before employees begin work.

25-A-04-093.02 to CMS - Open Unimplemented
Update expected on 02/11/2026
We recommend that the Alabama Department of Public Health educate nursing homes on the importance of conducting timely background checks and Registry queries.

25-A-04-093.03 to CMS - Open Unimplemented
Update expected on 02/11/2026
We recommend that the Alabama Department of Public Health require nursing homes to develop policies and procedures to conduct Registry queries before employees begin work.

25-A-04-093.04 to CMS - Open Unimplemented
Update expected on 02/11/2026
We recommend that the Alabama Department of Public Health conduct a review of nursing homes' compliance with background checks and Registry check requirements.

View in Recommendation Tracker