Health Law Daily Wrap Up, AUDITS AND MONITORING—OIG REPORTS: Audit finds Alabama failed to consistently verify nursing home employee background checks, (Aug 19, 2025)
An OIG audit found that Alabama did not always ensure nursing homes complied with federal and state background check requirements, leaving residents potentially at risk.
The HHS Office of Inspector General (OIG) has found that Alabama did not consistently verify whether nursing homes were complying with background check requirements intended to protect residents. The audit reviewed the period from January 1, 2022, to April 8, 2024, focusing on whether nursing homes followed federal and state rules that bar individuals with disqualifying backgrounds from working in long-term care facilities. Given that nursing homes serve approximately 1.4 million residents, many of whom are vulnerable and rely on Medicaid, the report emphasized the importance of strict compliance with these safeguards (OIG Report, No. A-04-24-08104 (Aug. 14, 2025)).
OIG’s findings. Of the 439 nursing home employees sampled, the OIG found that 139 had not been properly vetted according to requirements. In these cases, facilities either failed to complete background checks before employment, neglected to check the Alabama Elderly and Adult in Need of Protective Services Abuse Registry, or missed both requirements. These lapses left open the possibility that individuals with prohibited backgrounds could have worked with nursing home residents.
OIG’s recommendations. To address the deficiencies, the OIG recommended that Alabama establish a process to verify that both background checks and registry queries are completed before new hires begin work. Additional recommendations included educating nursing homes on the importance of timely screenings, requiring formal policies for registry queries, and conducting broader compliance reviews of facilities.
Alabama’s response. In response, the state agency agreed with the recommendation to develop a verification process but did not fully commit to the others. However, it did outline several actions already taken or planned to improve oversight and compliance. The OIG noted that full implementation of its recommendations would help strengthen protections for nursing home residents across Alabama.
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