Beyond the Pale: Coordinated Conspiracy to Graduate Fake Nurses Begs the Question of Preparedness to Identify Credential Fraudsters before Harm Results

February 23, 2023

Providers, employees, contractors, and vendors form the backbone of the healthcare industry. Unfortunately, as witnessed by the recent fake nursing credential scandal, these same individuals can also represent risk. This deeply disturbing scam should concern health system leaders and staff, licensure and regulatory bodies, professional organizations, educational institutions, patients, and communities. Fraud is never a victimless crime. False credentials will put quality patient care at risk, among other adverse consequences for those who employ and bill for services delivered by imposters. It is important for healthcare institutions to take measures to protect personnel and patients. The onus is on leadership to ensure it is employing credentialed professionals.

The sinister scheme, coined as Operation Nightingale by federal law enforcement, was initiated by several academic nursing programs to sell fake nursing degrees and academic transcripts. It is a story of fraud, betrayal, and harm. The extremely lucrative operation was busted by authorities in late January 2023. It is the classic story of leveraging vulnerabilities when systems are compromised and ripe for abuse. In this instance, the culprits capitalized on Florida’s nursing shortage and exploited the COVID-19 pandemic when online interviews became prevalent, creating a golden opportunity for applicants who aren’t quite what they seem. Regardless, the racket has shaken public confidence in healthcare institutions to ensure care by qualified, competent professionals.

More than 7,600 fake nursing diplomas and certificates were sold by three accredited South Florida nursing schools to nurse candidates who preferred to forgo the prerequisite efforts required to sit for the national licensure exam. According to news sources, the alleged co-conspirators reportedly made $114 million from the scheme, which dates to 2016. To date, enforcement action has spanned multiple states including Florida, New York, New Jersey, Texas, and Delaware. If convicted, defendants face a statutory maximum of 20 years in jail for the charges of wire fraud and wire fraud conspiracy, the DOJ has reported.

Nursing candidates paid $10,000 to $15,000 for the fraudulent diplomas, allowing them to avoid the rigorous academic education and clinical training to become qualified, competent caregivers. These fake documents allowed 2,800 pay-to-play-a-nurse individuals to pass the National Council Licensure Examination. Many of the degree recipients went on to work at hospitals, nursing homes, and Veterans Affairs medical centers, among other settings. Officials have said it will be up to licensing boards to act against those individuals under their purview. Whatever the motivation, the masterminds and their complicit “customers” will be held to account for participating in the scam. This fraud will never be reconciled with respect to its impact on patient care quality, nor the fact that patient health and safety were knowingly and deliberately put at risk. Harm was perpetrated by these pretend nurses who delivered direct clinical care to patients across multiple settings. The actions of these academic nurse leaders and nurse imposters have resulted in reputational harm to the nursing profession, which will overcome the temporary setback- because nurses are resilient. This story is far from over.

Is this the tip of the iceberg? This a fair question to pose and time will tell as well to learn more. What can be done now by your own organization? There are actions to take immediately to assess risk and ensure that robust systems are in place to verify the credentials of staff who are viewed as Healthcare Heroes by the community.

  1. Hospitals and health systems should confirm they are not employing any nurses who graduated from the now-shuttered nursing schools and act as appropriate.
  2. It is also important to remain informed about whether payers will become aggressive and seek to recover payment for services delivered by nurses who lack the required credentials for the position.
  3. Be proactive. Consider this offensive assault by unscrupulous nursing educators and administrators as an opportunity to examine the standards and practices within your organization. This is where current HR policies, procedures, and adherence to them are most critical. Improvement will occur by identifying systemic weaknesses in policies, procedures, and practices that put the enterprise at risk.
  4. With remote working environments providing a new avenue for bad behavior by opportunists, employers need to pay close attention when hiring employees virtually. Employers must implement robust protocols and technologies to stop scammers from becoming employees.
  5. Shore up compliance with new tools and strategies. For example, consider automated, real-time integrity checks on the organization’s entire ecosystem (employees, vendors, contractors, medical staff, and prospective hires) on an activated set of data sources. Put continuous compliance on autopilot with IntegrityShield.

It is imperative that healthcare organizations reinforce their compliance programs to keep the “bad apples” from delivering care or providing other related services. Getting integrity screening systems right will prevent avoidable harm and ensure that the organization excels with vetted, authentic professionals who support the mission to deliver exceptional patient care.

You may also like to read our blogs on the exploitation of water pump controllers by hackers, the breach of Kaiser Permanente, and the ransomware attack on Universal Health Services.

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