Although the overwhelming majority of healthcare professionals prioritize compliance, medical ethics, and patient safety, the unfortunate reality is that some do not. It’s for this reason that healthcare background check requirements remain strict.
However, regulatory expectations, best practices, and technologies continually shift and improve, making it difficult for providers, administrators, and other professionals to stay current.
This article compiles an updated guide for those looking to refresh their knowledge or refamiliarize themselves with healthcare background check requirements and healthcare compliance program benefits. For a deeper look at how modern tools and best practices are transforming healthcare vetting, explore our healthcare background screening solutions to see how automated, compliant screening helps organizations protect patients and maintain regulatory confidence.
Why Background Checks Matter in Healthcare
Credentialed and other employees undergo healthcare background checks as a precautionary measure to protect patient safety and organizational reputation. Consistently preventing fraud, abuse, and liability remains a top concern when malpractice expenditures—among other consequences—approach $60 million annually in the US.
By ensuring prospective (and current) employees adhere to these healthcare regulations, healthcare facilities hold greater certainty that their staff is knowledgeable, capable, and responsible.
On an institutional level, healthcare facilities must also adhere to legal and accreditation requirements. External professionals normally perform these strict compliance assessments using predefined standards to identify areas that exceed performance benchmarks or need improvement. In cases where providers or facilities don’t meet industry expectations, evaluations help ensure accountability.
Types of Background Checks Used in 2025
Healthcare background check requirements can vary under federal and state authorities. Still, most background checks consist of similar vettings, as the following screenings show. To better understand how each background screening component fits into a comprehensive compliance strategy, visit our healthcare background screening page.
Criminal History Checks
As with many occupations, healthcare professionals normally undergo criminal background checks before being hired. Among the most important concerns are placement on a sex offender registry or any history within healthcare of fraud, abuse, neglect, or exploitation. This verification normally involves national, state, and county-level records to ensure thoroughness.
Certain care professions may also require specific criminal background check criteria that must be followed in the absence of any state requirements. For example, § 418.114 Condition of participation: Personnel qualifications specifically pertains to hospice workers. Here, the Code of Federal Regulations (CFR) states that if a hospice worker’s job requires “direct patient contact or access to patient records” and no state requirements exist, they must undergo a background check involving all states of residency or occupation for the previous three years.
Sanctions and Exclusion Lists
Beyond the standard liabilities of hiring people with certain histories, healthcare facilities can expose themselves to government action if they aren’t careful in vetting new hires with healthcare sanction background checks. For example, the Health and Human Services (HHS) OIG Exclusion List acts as a database of individuals and entities who are currently not permitted to work at or provide goods or services to federal healthcare programs like Medicare, Medicaid, and Veterans Affairs.
Most individuals will only be found on the OIG Exclusion List—also known as the OIG’s List of Excluded Individuals and Entities (LEIE)—for a temporary period after being found guilty of various types of fraud or abuse. Generally, the exclusion term ranges between one and five years, depending on the reason behind their exclusion and its severity (e.g., felony, misdemeanor).
Additional exclusion or sanction lists to monitor and enforce include (but are not limited to):
- US System for Award Management (SAM)
- Office of Foreign Assets Control (OFAC)
- Specially Designated Nationals and Blocked Persons List (SDN)
- Medicare Opt-Out
- Centers for Medicare and Medicaid Services’ (CMS) Preclusion List
License and Education Verification
Before hiring healthcare professionals for qualifying roles, facility administrators must confirm that the individual holds all necessary licenses, certifications, and diplomas. Some states extend this verification process to authenticating these materials to ensure they aren’t fraudulent or counterfeit. Some states may also enforce license and education verification even for non-medical/non-patient-facing positions. Ensure every credential is valid and up to date with our healthcare license verification tools, designed to streamline primary source verification and protect against credential fraud.
New Trends in Healthcare Background Screening
As investigative and database capabilities continue improving, it’s not uncommon to see healthcare professionals undergo new types of screenings for more thorough or ongoing vetting.
Continuous Monitoring Post-Hire
Most states require that healthcare workers undergo background checks on a periodic basis throughout their employment. However, aside from past records not guaranteeing future conduct, legal processes often take considerable time; a healthcare professional currently under investigation for Medicare fraud may not be placed on the Exclusion List until due process finishes, which could take months or years.
While healthcare facilities have long been encouraged to perform continual vetting, the emergence of real-time alerts is a rapidly growing trend made possible by dataset and database sophistication. Automatically notifying administrators about exclusions and convictions significantly reduces the burden of continuous or periodic vetting. Maintaining ongoing compliance requires more than one-time checks. Learn how healthcare compliance monitoring solutions enable continuous oversight, automated exclusion alerts, and proactive risk prevention across your workforce.
Expanded Data Sources and Automation
Further examining capabilities emerging around data sets and databases, healthcare administrators benefit from leveraging APIs to rapidly synchronize information across multiple systems. Given healthcare’s past challenges with siloed technological resources (partially due to HIPAA), these integrations represent a major leap forward. Beyond configurations, some services may also leverage artificial intelligence (AI) to automate processes or experiment with predictive modelling.
Greater State-by-State Variation
With individual states granted significant authority regarding healthcare professionals’ licenses, certifications, and education standards, differences between each state’s background check requirements naturally proliferate. For example, some states—like Florida—require ‘Level 2’ screening that consists of fingerprint verification. In Maine, the valid ‘look-back’ period of any background check for medical licenses extends to ten years.
Given the state-by-state variations (and other regional differences), healthcare professionals on both sides of hiring processes or ongoing vetting should familiarize themselves with the requirements specific to their applicable jurisdictions at the local, state, and federal levels.
Common Pitfalls to Avoid
The most common issues healthcare administrators and facilities encounter when conducting background checks involve lax investigations. When vetting only relies on national databases, significant ‘red flags’ may go unnoticed; the same holds for failures to periodically update background checks. Additionally, ambiguous screening policies can lead to administrators approving of hires they shouldn’t.
Best Practices for Effective Background Checks
Instead, the most effective background check procedures involve the following:
- Establishing clear, role-based standards in accordance with federal, local, and state laws; any updates must be similarly communicated to all healthcare employees in a timely manner.
- If partnering with healthcare-focused, compliance dataset vendors for more robust screening processes, be sure to thoroughly evaluate the entity and its own credentials—such as receiving a Credentials Verification Organization certification from the National Committee for Quality Assurance (NCQA) and compliance with the Fair Credit Reporting Act (FCRA)
- All internal processes, controls, and official communications related to background checks must be documented and audited consistently for the most thorough liability protections.
Strengthening Trust Through Screening
Background checks of different types—criminal, sanctions or exclusions, licenses and education, continuous monitoring, and more—remain regulatory and operational necessities for healthcare professionals. Patient safety and a healthcare entity’s reputation depend on thoroughly vetting both applicants and existing employees.
To further ease any friction or delays caused by these mandatory assessments, administrators and facilities should continuously update their background check policies, implement smarter screening tools, and partner with reputable vendors for compliance datasets, like Verisys.
Reach out to our team today to learn more about how we can help with compliance audit preparation, vendor credentialing compliance, and more.
Sources:
NIH PubMed. Accreditation Made Easy: Step-by-Step Guide for Healthcare Institutions. https://pmc.ncbi.nlm.nih.gov/articles/PMC11554392/
HIPAA Journal. Background Checks for Healthcare Employees https://www.hipaajournal.com/background-checks-for-healthcare-employees/
HIPAA Journal. What is the HHS OIG Exclusions List? https://www.hipaajournal.com/hhs-oig-exclusions-list/
Florida Agency for Healthcare Administration. Screening Information. https://ahca.myflorida.com/health-quality-assurance/bureau-of-central-services/background-screening/screening/screening-information
Restoration of Rights Project. 50-State Comparison: Limits on Use of Criminal Record in Employment, Licensing & Housing. https://ccresourcecenter.org/state-restoration-profiles/50-state-comparisoncomparison-of-criminal-records-in-licensing-and-employment/
