Quick answer: Hospices certified by Medicare must obtain criminal background checks on employees and contractors with direct patient contact, following state law (42 CFR 418.114). Most employers also screen sex-offender registries, federal exclusion lists, identity (SSN trace), licenses, and employment history before the first patient visit.
- Federal Medicare rules set the floor; your state may require fingerprint checks, abuse registry searches, or longer lookbacks.
- A criminal check alone is not enough: add exclusion list, license, and identity verification.
- Follow FCRA disclosure and adverse-action steps, and weigh convictions individually per EEOC guidance.
What federal rules require for hospice staff
The Medicare hospice Conditions of Participation, 42 CFR 418.114, require a hospice to obtain a criminal background check for employees and contracted staff who have direct patient contact, in line with state requirements. The rule also addresses timing: checks should be completed close to the date of hire, and the hospice must not employ individuals whose records bar them under state or federal law. Verify the current text and timing language in the eCFR before finalizing your policy (see Sources).
Separately, federal health programs will not pay for items or services furnished by excluded individuals. The HHS Office of Inspector General maintains the List of Excluded Individuals/Entities (LEIE), which compliance teams commonly check at hire and on a recurring basis.
Where state law adds requirements
States layer their own rules on top of the federal floor. Depending on where you operate, expect some combination of:
- Fingerprint-based state and FBI checks submitted through a state agency
- Nurse aide, abuse, or neglect registry searches
- Specific disqualifying offenses and lookback periods
- Provisional-hire rules while results are pending
Confirm requirements with your state licensing agency. If you staff across state lines, build a state-by-state matrix rather than one national policy.
Which screens to run, by role
| Role | Typically screened | Why |
|---|---|---|
| RN / LPN / CNA / home health aide | National and county criminal, sex-offender registry, SSN trace, license and education verification, exclusion check, employment verification | Direct patient contact; license and exclusion status affect billing and compliance |
| Social worker, chaplain, counselor | Criminal, sex-offender registry, SSN trace, credential verification, exclusion check | Unsupervised access to patients and families at home |
| Volunteers with patient contact | Criminal, sex-offender registry, identity check | Same vulnerable population, often less formal onboarding |
| Drivers (transport, supply delivery) | Criminal, motor vehicle record (MVR), SSN trace | Driving record affects safety and insurance |
| Billing and records staff | Criminal, SSN trace, employment verification, exclusion check | Access to patient records and payer systems |
Why county and federal searches matter
A single database search can miss records. Pairing a national criminal search with county court searches in every county where the candidate has lived, plus a federal search, gives broader coverage. An SSN trace helps surface the names and addresses that tell you where to search. Reveal Background runs these searches, along with sex-offender registry, MVR, employment and education verification, with same-day results on most searches, on a pay-per-report basis with no setup fee.
Drug testing for hospice employees
Hospice agencies handle controlled substances such as opioids, so many adopt pre-employment drug testing. Federal law does not generally mandate it for hospice staff, so it is an employer policy decision. Apply it consistently to the same job category, state your panel and cutoff levels in writing, and follow state testing laws. Reveal clients can order testing through American Screening Corp.
Staying compliant while you screen
FCRA steps
When you use a third-party screening company, the Fair Credit Reporting Act requires a standalone written disclosure, the candidate’s written authorization, and a pre-adverse action notice (with a copy of the report and a summary of rights) before you decide against hiring based on the report. Send a final adverse action notice afterward.
EEOC and individualized assessment
EEOC enforcement guidance warns that blanket exclusions for any record can create disparate impact under Title VII. Consider the nature of the offense, time elapsed, and relevance to the job, and give the candidate a chance to respond. Where state or federal law mandates disqualification, document that as the basis for the decision.
Hospice background check checklist
- Confirm your state’s disqualifying offenses, fingerprint, and registry requirements
- Collect FCRA disclosure and authorization before ordering anything
- Run national, county, and federal criminal searches
- Check the sex-offender registry and any state abuse or nurse aide registry
- Run an SSN trace to confirm identity and search locations
- Verify licenses, education, and recent employment
- Check the OIG exclusion list at hire and on a recurring schedule
- Order an MVR for anyone who drives for patient visits
- Apply an individualized assessment and the adverse-action process
- Keep results confidential and retain records per your policy and state law
Setting up the process
Define screening packages by role so recruiters do not improvise. Start the check at conditional offer, and do not schedule unsupervised patient contact until results are back and cleared. You can create an account at app.revealbackground.com and order only the reports each role needs.
Frequently asked questions
Are background checks required for hospice workers?
Yes. Medicare’s hospice rules (42 CFR 418.114) require criminal background checks for employees and contractors with direct patient contact, according to state requirements. States may add stricter rules.
Do hospice volunteers need background checks?
Federal rules focus on employees and contractors, but many states and hospices screen volunteers with patient contact. Check your state requirements and apply a consistent policy.
How far back does a hospice background check go?
It depends on state law and your policy. Many states set specific lookbacks or permanent disqualifiers. Some laws limit reporting periods, so confirm local rules before setting a standard.
Can a hospice hire someone with a criminal record?
Sometimes. If state or federal law bars the offense, no. Otherwise, assess the offense, its age, and relevance to the role, and follow FCRA adverse-action steps if you decline.
Sources
- eCFR: 42 CFR 418.114, Personnel qualifications (hospice)
- HHS OIG: List of Excluded Individuals/Entities
- EEOC: Enforcement Guidance on Arrest and Conviction Records
This article is general information, not legal or medical advice.
