A Pandemic, A Nursing Shortage, and 7,600 Fake Nursing Diplomas

On January 27 of this year, I awoke to read my morning copy of the New York Times for a sense of the latest news of the day. As I began to glance at the headlines while drinking my coffee, I almost choked on a headline I never imagined I would ever be reading:

7,600 Fake Nursing Diplomas Were Sold in Scheme, U.S. Says

Twenty-five people were charged this week in connection with the scheme, which involved the sale of fake transcripts and diplomas issued by three Florida schools, prosecutors said.

Buyers paid between $10,000 and $15,000 to obtain bogus diplomas and transcripts indicating they had earned legitimate degrees, like the associate degree in nursing; that degree can take two years to complete.

The diplomas and transcripts then allowed the buyers to qualify for the national nursing board exam, prosecutors said. About 37 percent of those who bought the fake documents — or about 2,800 people — passed the exam, according to the Times article.

With over 45 years of experience as a medical center investigator, I've had occasion to investigate allegations of bogus credentials among health care providers. These incidents rarely surfaced, and when they did, it was usually on an individual basis. What shocked me was not that a fraud had been committed, but the size and scope of this scam involving nursing education.

My first case involved an individual who was employed as a physician at the VA Medical Center in the Bronx, NY. He only possessed a bachelor's degree in Chemistry from India but had provided bogus diplomas to indicate a medical degree. Other cases involving fraudulent diplomas and certificates would periodically surface, including degrees from diploma mills that only required payment and no course work for Bachelors, Masters, and even PhDs. This included the Director of Hospital Engineering who was responsible for maintaining the life-saving systems in a hospital setting.

Even the best credentialling departments can only rely on information provided by former employers and available to hospitals and the public. Two of the "schools" involved in this nursing degree fraud were at one time licensed facilities. According to an article in the Miami Herald, The Palm Beach school was previously licensed by the Florida Board of Nursing as a legitimate nursing education program, but its license was terminated in May 2017 due to low passing rates on the state certification exam. The Siena Nursing School also had its license placed on a probationary status in 2020 due to low passing rates on the certification exam. This could explain why some credentialling departments may have assumed the degrees to be legitimate. These diplomas surfaced in Veteran's hospitals in New York, Maryland, and Georgia as well as the private sector.

Will those individuals who purchased and then submitted these bogus documents to gain employment be criminally prosecuted? It doesn't appear likely. They will lose their jobs, but perhaps may resurface again somewhere else. One famous nursing fraud case did result in criminal prosecution.

One of the most outrageous cases of bogus nursing education appeared in 2009 in the Stamford Advocate titled, Fake Nurse of the Year Sent To Jail. "After being investigated by the state Medicaid Fraud Control Unit between March and August 2009, Betty Lichtenstein was charged with illegal use of the registered nurse title, six counts of second-degree reckless endangerment, and criminal impersonation. Three months earlier, she was arrested for forging a prescription for pain killers that she obtained on the job while she was pretending to be a nurse for Dr. Gerald Weiss in Norwalk. In November 2008, according to her arrest affidavit, she received the 2008 Nurse of the Year award at a dinner supposedly hosted by the Connecticut Nursing Association. Investigators in the Medicaid Fraud Control Unit of the Chief State's Attorney's Office determined that no such organization exists, and that she spent $2,000 of her own money to stage the event, the affidavit said."

The art and science of medical credentialling has improved dramatically since the 1990s when I first encountered bogus medical credentials. The case that really brought the matter to the attention of the public was that of Dr. Michael Swango who was employed at numerous medical centers despite having spent years in prison for poisoning his coworkers. He was eventually tried and convicted of being a medical serial killer, having murdered an estimated 60 of his patients. He simply lied about his background and no hospital system confirmed the information on his CV including the United States government.

Has the pandemic and the urgent need for professional health care workers forced some institutions to shortcut the credentialling process and return to the bad old days? Has it become more commonplace to rely on outside agencies that provide these personnel to vet nurses correctly and accurately? If an institution is suffering from severe personnel shortages, will it, perhaps reluctantly, look the other way?

I sincerely hope that medical centers will begin to renew their commitments for thorough and comprehensive vetting of all medical professionals before they are hired and not after some headline or incident forces this to occur.  My last case involved a traveling nurse who stole drugs from the hospital pharmacy. After she was caught, we learned she had previously stolen drugs from her former employer, which was not disclosed when she was retained. We can and must do better than this. Just like the Swango case, let this terrible scam be a second wake up call to medical administrators across the country.