Ohio May Require Healthcare Navigators to Pass Background Checks

By Michael Klazema on 10/7/2013

As part of Obamacare, healthcare navigators will assist individuals in registering for benefits. However, Obamacare does not contain any provisions for background checks for healthcare navigators. This has left legislators in many states, including Ohio, concerned about the possibility of healthcare navigators with criminal backgrounds committing fraud or other crimes against the consumers they are meant to be helping.

Ohio’s Rep. Barbara Sears has introduced a bill that would use mandatory background checks to help protect consumers against this risk. Sears cites shortcomings in the federal law as the reason she introduced the proposal for a state law. “There is nothing in place to protect consumers,” she said of the federal law, “especially with the amount of financial and other personal information the navigators will have access to.”

Healthcare navigators collect tax information and Social Security Numbers as part of their jobs, so it would be particularly easy for them to commit identify theft. The US House of Representatives Committee on Oversight and Government Reform highlights this problem in a report which found that “the main concern for consumers is the heightened risk of identity theft and financial loss from a poorly managed outreach campaign.” Because of the lack of a background check provision in the federal law, unless states enact their own laws, it is possible that healthcare navigators hire a convicted felon—including one with a fraud conviction—to work as an adviser.

Ohio’s proposed legislation seeks to solve this problem by requiring healthcare navigators to complete a background check, certification, and training through the Ohio Department of Insurance. The exact details of the type of background check that will be used, its scope, and the types of convictions that will be considered grounds for denying employment are unclear.

Ideally, the state would be using a national background check product rather than a state-based one, as this would enable the discovery of an individual’s complete public criminal history. For example, a tool like US OneSEARCH from could be used. This national background check tool compares a name and date of birth against a collection of over 450 million public criminal records taken from state and local databases across the country. It returns its results almost instantly and is very affordable.

When it comes to reviewing the results of the background checks, one could consider reviewing cases for individuals convicted of fraud, identify theft, grand theft, or a violent crime that might pose a risk to consumers as a healthcare navigator. Sears says that if the measure is passed, healthcare navigators in Ohio will be required to meet many of the same standards as insurance agents and brokers, thus providing improved consumer protection.


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