Know before you hire: Screening prospective employees

When hiring, providers are required to perform proper verification checks to confirm that prospective employees are cleared to work for a Medicaid provider. This requirement applies to all prospective employees, including individuals who provide direct care to clients, unlicensed employees with face-to-face contact and administrative staff. These tools help prevent bad actors from obtaining employment within Texas Health and Human Services programs and reduce the potential for exploitation of the most vulnerable Texans.

One requirement to ensure employment eligibility is to verify prospective employees are not on the state or federal exclusions lists. Federal and state OIGs may prohibit people and businesses from participating as Medicaid providers for several reasons. Typical actions that have led to exclusions include:

• Loss of license or other certification to practice.
• Prior criminal convictions for certain offenses, such as health care fraud.
• Patient harm or delivering services below the profession’s standard of care.
• Billing for services not rendered or not medically necessary.
• Illegal solicitation of clients or offering kickbacks in exchange for business.

As a reminder, providers must also screen their current employees and contractors every month to verify whether or not they are excluded according to the HHS OIG’s Texas Exclusions List and the United States Health and Human Services OIG List of Excluded Individuals/Entities (LEIE) as required by the Texas Medicaid Provider Procedures Manual.

In addition to checking the exclusions lists, providers of Medicaid products and services must verify employment eligibility for all prospective employees, including unlicensed individuals, subcontractors and volunteers by searching the HHSC employee misconduct registry and the HHSC nurse aide registry. These requirements are in accordance with Title 26 Texas Administrative Code, Section 52.107(a).

There have been cases in which providers discovered they have employed an excluded individual. The OIG settled a case in October 2023 with a Weslaco home health provider. The provider employed a personal care attendant who was on the Employee Misconduct Registry after an arrest for an offense that subjected the individual to exclusion. The provider also improperly submitted claims for billing personal care attendant services that the attendant never rendered. The provider worked collaboratively with the OIG to resolve these issues, and the OIG agreed to a settlement of $35,136.

If a provider utilizes a third-party contractor to run background checks on prospective employees, including those who are unlicensed, volunteers and contractors, ensure they are running a thorough search. This includes background checks via Texas Department of Public Safety (DPS) in accordance with Title 26 Texas Administrative Code, Section 558.247(a)(1) and Texas Health & Safety Code Section 250.004(a). Criminal history checks must be conducted in compliance with the Health and Safety Code, which requires a criminal history record from DPS.

If a provider discovers that they have employed an individual who has not been cleared by a DPS criminal history check or who is on the exclusions list, it is best to self-report this error to the OIG. Consult the OIG’s Self-Disclosure Protocol to learn more about the benefits of self-disclosure, how to submit a self-disclosure report, the method for calculating damages from employing an excluded person and more. Providers and managed care organizations may also use the OIG Fraud Hotline (800-436-6184) or ReportTexasFraud.com, to report any compliance or overpayment matters relating to themselves.