By Elizabeth Hogue, Esq.

Approximately one year ago, the FBI and the Department of Justice conducted “Operation Nightingale,” which focused on a scheme to issue fake nursing degrees at three schools.
While still operational, the schools issued seven thousand six hundred fraudulent diplomas and transcripts that were sold to aspiring nurses who paid up to ten thousand dollars for them, but did not complete the necessary coursework. Florence Nightingale would be horrified, indeed!

These nurses are not the only imposters among us. In March, a teenager posed as a PA at several Texas hospitals. A Michigan woman currently faces seven years in prison for using another person’s identity to gain employment as a nurse.  

What should providers do to identify imposters? First, they must, of course, comply with requirements in the states in which they do business. In addition, providers likely need to take actions that may include: 

  • Federal background checks 

  • Verification of all required education, licenses, and certifications 

  • Monthly licensure checks that may be accomplished by using bots 

  • Urging patients and employees to report anything they see that may call practitioners’ licensure into question 

  • Frequent competency checks 

  • Criminal background checks 

  • FBI background checks 

  • Verification of employment for the past three years. 

In other words, vigilance is needed. 

Inevitably, despite concerted efforts by providers, imposters will slip through the cracks. 

There are many implications of services provided by imposters. One is, of course, the possibility of injuries to patients. Also, providers may wonder if they are liable under the False Claims Act for services provided by unlicensed individuals. 

Southern Maryland Home Health Services hired an individual as a physical therapist (PT) who was unlicensed, even though she claimed to be a fully qualified PT. She used the name of an actual licensed PT as her own and provided false references from purported former employers in order to be hired. In addition, the provider’s hiring agent who interviewed the PT said that the PT was familiar with PT terminology and procedures. While she was employed, the provider did not receive any complaints about the unlicensed PT that would have put the provider on notice that she was an imposter. 

Consequently, the U.S. District Court for the District of Maryland concluded that providers are only liable for false claims for services provided by imposters if some degree of culpability other than simply employing an imposter is attributable to employers. In other words, so long as providers comply with their internal policies and procedures and state and federal requirements and nothing occurs that puts employers on notice that staff members are imposters, it appears likely that providers will not have any liability for filing false claims for services provided by imposters. 

It’s scary to think about the provision of healthcare services by unlicensed personnel. The consequences could certainly be dire for both patients and providers. Vigilance by providers, however, will undoubtedly pay off. 

©2024 Elizabeth E. Hogue, Esq. All rights reserved. 

No portion of this material may be reproduced in any form without the advance written permission of the author.