How to combat license fraud with healthcare license verification

How to combat license fraud with healthcare license verification

Nurses help people. Nurses care. Nurses are to be trusted. So, would it surprise you that some people who practice as a nurse, are not actually nurses? As sad as it is, it happens. There are numerous cases each year where a person either claims to be a nurse and was never licensed, or who practices even though their license was revoked or suspended. Check out the OIG site to read about recent enforcement actions which include cases on fraudulent licenses.

So how do you know if you have an employee who is not actually licensed?

Here are 4 steps to combat healthcare license fraud and to ensure your staff is properly licensed and qualified through healthcare license verification:

1. Be original & verify –

Ask for a copy of the license (or better yet, ask for the original, and make a copy) and then verify it with the state Board of Nursing that issued it. If the individual has either altered, fabricated or stolen someone else’s license, it will not match up.

For instance:

  • Check to see if the name matches your employee/applicant.
  • Check to see if the date of issuance has been altered or modified compared to the date confirmed by the Board.
  • Check to see if the person would have been at least 18 or older when issued.
  • Check the license number and expiration date – make sure they match the name and make sure the license is current.

2. Verify if it is a multi-state license –

Check to see if the nurse claims to have a multi-state license. If so, double check at this site to make sure the state issues and/or recognizes a multi-state license. If an individual presents a multi-state license, their primary state must be the state where they obtained the license. If they provide a home address other than the state that issued the multi-state license, confirm their privilege to work in the issuing state is valid. Verify the license with the nurse compact license state that issued the license.

3. Verify, verify, verify and then verify again –

When verifying the license at the state Board of Nursing, determine if there are any current sanctions, disciplinary actions or limitations on the license. Some states issue temporary licenses and require certain affirmative steps to be taken in a defined period of time in order to convert the license to a permanent license status. If there are restrictions, such as requiring supervision or meeting certain conditions, such as, not delivering scheduled drugs, then make sure you know the limitations can demonstrate compliance.

4. Social Security Number –

Finally, to avoid accepting a fraudulent license, or one that has been stolen through identity theft, you should conduct two additional searches:

  • (1) Social Security Death Master Index search. This will determine if the SSN provided is associated with a deceased individual. If so, then there is the distinct possibility of identity theft.
  • (2) Confirm with IRS the SSN belongs to the individual.

Be sure to watch for the lack of demonstrating competency which could evidence inconsistency with the license granted. In order to keep the license current or valid, and, to practice in certain positions or certain settings (ie hospital pediatric unit), a nurse is required to attend continuing education, as well as obtaining and maintaining certain certifications (CPR, BLS, or ACLS).

What’s next?

If you determine the nurse is acting without a proper license, report the case to the Board as soon as possible. The good news: most nurses are who they say they are and have the competency, training and licenses to perform. The outliers are the risks you have to find and avoid at all costs.

We hope this helps! Feel free to reach out, or comment below, if you have any further questions!

Happy verifying.

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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