50-State Guide to Healthcare Hiring Rules and Background Check Laws

You don’t want to hire anyone dangerous to work with your patients, but your state may have background check laws that keep you from asking about convictions too soon. At the same time, the HIPAA Journal says that all healthcare providers are required to conduct background checks for healthcare employees. So which is it? Ask now and risk non-compliance, or ask later and risk your practice’s reputation? Here’s what background checks actually cover, and what your state says about timing those screening questions.

Background Check Law Basics for Practice Owners

When you run a pre-employment background check, you’ll typically see things like identity verification, employment history, education, and criminal records. Some reports take it a step further and look into driving records and credit history. Do you really need all that information, though? Your state may think not. 

And frankly, the depth of your background check is going to depend on the job you’re hiring for. A pediatrician will be held to much higher employment standards than a receptionist. Not that one job is more important than the other. They just have different duties and the safety responsibilities to match.

What should be consistent is the way you approach background checks. Make your policy transparent and consistent across job types and roles. That way, you won’t miss important screenings, nor will you accidentally discriminate.

This guide does not provide legal or hiring advice, so you should check with your employment attorney before making any decisions. This is a quick overview of what you might look for, and where your state draws the line.

Criminal Background Checks and Ban the Box Rules

Many states now have Ban the Box laws. This rule, which prevents employers from asking about conviction or arrest records during the initial application process, is meant to give candidates a fairer chance at employment. Under these laws, background checks are still legal, but not at the initial hiring stage. This effectively forces employers to review qualifications before ruling out candidates based on criminal records. 

But in the interest of patient safety, this rule sometimes needs to be overridden. It totally depends on the state, job type, and convicted offense. You may even be required to run a criminal or sex offender background check, especially if your practice handles controlled substances or supports vulnerable patient populations.

Certifications and Education History

Again, the health and dental industry makes background check rules a little grayer than in other industries. State law language may vary, but they all say one thing: You can’t have unqualified healthcare providers taking care of your patients. Providers absolutely must have records of their education, licensure, work experience, and any certifications they claim to have. 

If you were running a shoe store and you hired someone who claimed to have an MD, that’d be bad… but not a public safety hazard. In your industry, fibbing about education is genuinely dangerous. You may also have to keep up with the Office of the Inspector General’s List of Excluded Individuals/Entities (LEIE). Hiring someone who’s on the federal exclusion list could put your whole practice in jeopardy.

CE credits have less dramatic repercussions, but they’re also worth watching. Continuing education provides healthcare professionals of all stripes a chance to specialize and advance their careers. In turn, that advances your practice.

Other Types of Records and Background Info

Criminal history, identity verification, and education are the big ones, but there are other types of reports you might want to run. A credit report can show you whether someone handling your finances may be up to the tasks. Driving records are a must if you’re hiring travel nurses or ambulance drivers. Drug testing might be a good idea, too, if your state allows it.

But not all states will allow you to run these sorts of reports. Especially not if you don’t have a good reason for running them. 

What about snooping on social media? You can (and probably should) use social media to hire, and yes, you can look at your future employees’ public profiles to get the gist of their professionalism and behavior. But you cannot use social media to sneak around your state’s background check laws or try to figure out their protected characteristics. Follow the correct procedures that your state has set.

State-by-State Guide to Background Check Laws

No state is telling you that you can never conduct a background check. These laws are almost always about timing and disclosure. Don’t forget to collect a signed acknowledgement from the candidate when you’re ready to conduct a check. This keeps you compliant with your state’s disclosure laws and it shows your candidates that you’re not trying to pry. You’re just trying to make thoughtful hiring choices.

Be aware that some cities or regions have different (usually stricter) laws than the rest of the state. Double check your local laws before running any reports. 

Also, this checklist only applies to practice employees who are not healthcare providers, whose hiring processes follow much stricter and more specific laws. We’re also not covering state employers, since that’s a whole different type of employment.

Whatever You Find, Keep Your Documents Up to Date

HR for Health doesn’t conduct background checks, and we can’t make employment or legal decisions for you. But what we can do is help you set up the smoothest hiring and onboarding process ever, and then maintain all your records, paperwork, and certification documents in one un-lose-able place. State laws change, so when they do, you’ll be the first to know. If your employees’ certifications are coming up on their expiration dates, you’ll get an alert. When you need to update your policies, yep you guessed it, we’ll be there. 

Set up policies that make sense for your practice and keep you compliant. Start by making your very own free federal employee handbook.