Federal Law (FCRA)
The Fair Credit Reporting Act (FCRA) establishes the federal minimum requirements for employment background checks, including disclosure and authorization requirements, consumer rights, and the adverse action process. Many states impose additional requirements that employers must also follow.
Read FCRA OverviewRecommended Screening Components
The components below reflect common elements of a provider screening package. Requirements change based on the license held, the patients served, and whether the employer bills federal programs.
| Screening Component | What It Covers | Recommendation |
|---|---|---|
| License status, expiration, restrictions, and board discipline in every state of licensure. | ||
| Federal and state exclusion lists barring a person from federally funded healthcare. | ||
| Names and addresses associated with the applicant, which identify where to search. | ||
| Criminal records in the counties where the applicant has lived and worked. | ||
| Broad multi-state coverage that points toward records a county search would miss. | ||
| Fingerprint-based check, required by state licensing rules in most care settings. | ||
| Past employers and dates, which surface gaps a credentialing file must account for. | ||
| Degree, training program, and residency, confirmed through each institution. | ||
| Registry records, checked for roles treating children or vulnerable adults. | ||
| Pre-employment testing, common where the role has access to controlled substances. | ||
| Health screening and immunization status required for patient contact. | ||
| Ongoing checks against exclusion lists and license status during employment. |
Screening components should always be job-related and consistent with applicable federal, state, and local laws.
Notes on This Package
Providers are licensed in multiple states at once. A nurse or physician may hold licenses in several states, and each board keeps its own record. Discipline entered by one board does not appear automatically in another. Verification covers every state the person claims, not only the state where they will practice.
Board discipline is separate from criminal records. Boards investigate complaints and issue findings administratively, so a suspension or restriction can exist with no criminal charge behind it. A license can also be active but restricted, limiting practice settings, supervision requirements, or prescribing authority.
Screening is a subset of credentialing. Hospitals and health systems run a credentialing process covering training, board certification, malpractice history, hospital privileges, and peer references, in addition to the background report. The background report answers a narrow part of that file.
Checks continue after hire. Exclusion lists update monthly and licenses lapse on their own schedules. Organizations billing federal programs check exclusion status on a recurring basis rather than once at hire, which requires disclosure and authorization covering the period of employment.
Exclusion and Sanctions
Exclusion is the most consequential finding in provider screening, and it works differently from anything else in a background report.
What exclusion means
A federal exclusion bars a person from participating in federally funded healthcare programs. No federal program will pay for any item or service furnished by that person, whether they provide care directly or work in a supporting role. Some exclusions are mandatory following specific convictions, and others are discretionary.
Why the employer carries the risk
The consequence falls on the organization that employs an excluded person, since claims associated with that person become ineligible for payment and can carry penalties. This is why exclusion checks appear in packages for billing staff, contractors, and vendors alongside clinical roles.
Where the records live
A federal list is maintained and updated regularly, and most states maintain their own exclusion lists covering state programs. State lists are not consolidated federally, so a person excluded by one state may not appear on a search limited to the federal list. See Healthcare Sanctions for how these searches are run.
Where Screening Changes
The same license carries different requirements depending on the setting.
| Healthcare | Hospitals and health systems run full credentialing, including malpractice history, privileges, and peer references beyond the background report. |
| Social Services | Providers at licensed programs are screened against child abuse and adult protective services registries in addition to criminal records. |
| Staffing | Travel and per diem clinicians are screened by the agency to the standard the facility requires, and each new facility can add its own. |
| Education | School nurses and therapists are fingerprinted under state education law and screened against the disqualifying offense list covering school employees. |
| Government | Public health and correctional providers carry civil service rules and, at federal facilities, suitability determinations. |
| Nonprofit | Clinical programs at nonprofits check exclusion lists and verify licenses alongside the organization’s own volunteer and staff screening. |
Screening Considerations
Multi-State Licensure
Each state board keeps its own record, and discipline in one does not appear automatically in another. Compact licenses cover practice across states while the underlying record stays with the issuing board.
License Restrictions
A license can be active and still limited by practice setting, supervision requirements, or prescribing authority. Status alone does not show those limits, which appear in the board’s record.
Exclusion Checks
Federal and state exclusion lists bar a person from federally funded healthcare, and the payment consequence falls on the employer. Most states maintain lists that are not consolidated federally.
Controlled Substance Access
Roles that administer or dispense controlled substances carry diversion exposure. Board records show actions tied to prescribing, and drug testing appears in these packages more often than elsewhere in healthcare.
Training and Residency
Degrees, training programs, and residencies are each verified through their own institution. Foreign-trained providers add credential evaluation and longer timelines.
Employment Gaps
Credentialing requires accounting for gaps in the practice history, which is a longer standard than most employment verification applies. Gaps reflect training, leave, and relocation as often as anything else.
Ongoing Monitoring
Exclusion lists update monthly and licenses lapse on their own schedules. Recurring checks require disclosure and authorization covering the period of employment.
Agency and Contract Clinicians
Travel and per diem providers are screened by the agency employing them, to the standard the facility requires. Each facility can set additional requirements before granting access.
Common Questions
What is exclusion?
A bar from participating in federally funded healthcare programs. No federal program pays for services furnished by an excluded person.
Is exclusion a criminal record?
No. It is an administrative action recorded on a federal or state list. Some exclusions follow convictions and others do not.
Does a license show discipline?
Board records show current status and published disciplinary actions. Boards act administratively, so a finding can exist with no criminal charge.
Do we check every state of licensure?
Yes where a provider claims more than one. Each board keeps a separate record and does not share findings automatically.
How often are exclusion checks run?
Monthly is the common practice, since the federal list updates on that schedule and the payment consequence continues throughout employment.
Is credentialing the same as screening?
No. Credentialing covers training, certification, malpractice history, privileges, and peer references. The background report is one part of that file.
What does a restricted license mean?
The person may practice within limits set by the board, such as supervision requirements or restrictions on prescribing. The license remains active.
Who screens travel clinicians?
The staffing agency, as their employer, to the standard the facility requires. Facilities frequently add their own requirements before granting access.
Worth Knowing
An Excluded Provider Can Hold an Active License
Exclusion from federal healthcare programs and state licensure are separate systems that do not update each other. A provider barred from billing Medicare can still appear in good standing with the state board.