Healthcare license fraud is a reality – here’s how to avoid it

Healthcare license fraud is a reality – here’s how to avoid it

How can a company protect itself from a fraudulent employee?

For those of us who work in the healthcare industry, we all know how imperative and complicated healthcare licenses can be. Ensuring employee’s licenses are up to date and properly verified can be a headache for organizations industry-wide. Although organizations might think they are doing everything correctly and thoroughly, they could be terribly wrong. Errors in the healthcare license verification and tracking process is a very real possibility, especially in large companies that have thousands of employees and vendors. And yes, it is the company’s responsibility to verify all licenses and all other required documents.

 We recently published a blog series about the complications in the healthcare license verification process:
1. Primary source verification – what, where & when
2. Three common nuances in the healthcare license verification process
3. Time Delays in Healthcare License Reporting to State Licensing Boards

 How to eliminate healthcare license fraud in your company:

If an individual performs healthcare services as if she were that person and lacks the appropriate training or qualifications for such activity, it is not just morally reprehensible but exposes the public and innocent patients to unimaginable risk and harm.

You might be thinking to yourself, this never happens and/or is a rare occurrence. However, this does happen. In 2015, Massachusetts regulators revoked and/or suspended the professional license of 13 nurses after discovering health department documents revealed the nurses had lied about their degrees and about being licensed in other states. In 2003, Valorie Smith, RN, MS and Associate Director, published an informational article about the warning signs of healthcare license fraud when two nurses were found as imposters practicing without a healthcare license. We wrote an in-depth story about her article here. You can check the OIG’s website for recent healthcare fraud enforcement actions.

What to look out for:

  • Failure to provide the license
  • Provides copied and/or altered license
  • Look for non-uniform text, cut and paste lines, or a non-standard expiration date
  • Demonstration of competencies inconsistent with licensure
  • Inconsistent state of licensure information

Healthcare license verification best practices:

  • Receive the original license and only the original, and make a copy from the original
  • Do not allow an employee work a task that requires a license without first having received the license to verify it with the Primary Source.
  • Understand the Nurse Licensure Compact and the regulations concerning multi-state licenses.
  • Keep the files and copies of the staff’s licenses in a secure location.
  • Keep an open communication in reporting all cases of fraudulent activity to your state’s board of nursing.
  • Look carefully at the credentials provided and compare them to the actual individual applying for the position.
  • Verify the social security number matches the application.
  • Confirm the license documentation is from an actual university.
  • Check to make sure the license may belong to a maiden or former name associated with the application.
  • Activate a license verification process and verify the license with the state licensing board.
  • Do a background check to find if there are any past criminal records such as forgery or any other related fraud.
  • Monitor the license on a monthly basis to stay updated on the status if it changes or has any reported fraud associated and reported to the licensing board.


Healthcare organizations need to maintain an ongoing monitoring program as well as practice due diligence when onboarding new employees because the risks outweigh the costs. The significance of the healthcare industry should be reason enough to stop fraud and abuse across all organizations.

Michael Rosen, Esq.

Written by Michael Rosen, ESQ
ProviderTrust Co-Founder,

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year
Connect with Michael on Linkedin

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