Executive Brief Series: Insights on Recent OIG Enforcement Actions & Trends

Operation Nightingale and Protecting Your Organization from Potential Licensure Fraud

Written by A. Michael Rosen, Esq. and Donna Thiel

April 2024 Update: 3 Defendants Sentenced in Landmark Operation Nightingale Case

The fraudulent nursing diploma scheme known as Operation Nightingale saw a major development on April 2, 2024, when three defendants were sentenced to federal prison after they’d been found guilty of wire fraud and conspiracy to commit wire fraud charges in December 2023.

The Operation Nightingale scheme involved the sale of false diplomas and transcripts from multiple defunct nursing schools in Florida, which enabled the purchasers to sit for the national nursing board exam. Fraudulent diploma holders who passed the exam were given RN, LPN, and LVN licenses and entered the workforce through this illegal shortcut.

The three defendants include a former registrar and two former owner-operators of nursing schools involved in the scheme. Each defendant faced up to 20 years in prison for the charges. U.S. District Judge Raag Singhal sentenced the former registrar to 78 months in prison, one former owner-operator to 36 months in prison, and the other former owner-operator to 33 months in prison. Each defendant’s sentence will be followed by three years of supervised release. The court also ordered the three defendants to forfeit a total of $6,942,413.40 altogether and fined one defendant $20,000.

This sentencing represents a milestone in the investigation of the scheme that issued 7,600 fraudulent nursing diplomas, putting patients at risk and harming public trust in qualified healthcare professionals. In 2023, 27 defendants were charged and convicted for their participation in the scheme, and the healthcare industry still feels its effects today.

“Operation Nightingale leaves a mark on the already under-staffed profession of nursing. The schools involved have been shuttered as a result of fraud, but healthcare and now state license boards are left with tracking down these nurses and determining what to do with their state-issued licenses,” said Michael Rosen, co-founder of ProviderTrust. “Lesson learned: When it comes to the health of this country, nothing is more sacred than the true and valid education and credentials of those on the front line.”

Between 2016 and 2021, over 7,600 fake diplomas were sold to nursing students who used the fraudulent degrees to qualify for the National Council Licensure Exam (NCLEX). Aspiring nurses paid between $10,000 and $15,000 for these fake diplomas and transcripts, though many of these student nurses lacked the necessary coursework and credentials to earn those diplomas in the first place. Regardless, these student nurses were still granted qualification for the National Council of State Boards of Nursing (NCSBN) examination, and many of them gained employment and licensure after passing the test.

Three schools across Broward County and Palm Beach County, Florida, were involved in this multimillion-dollar fake diploma scheme: Siena College of Health, Palm Beach School of Nursing, and Sacred Heart International Institute. Though the schools have now been shut down, they accrued more than $100 million from selling fake diplomas and transcripts. In addition, an estimated 37 percent of student nurses with fake diplomas passed the NCLEX. According to federal authorities, these nurses then went on to gain licensure and employment at dozens of healthcare facilities nationwide.

On January 25, 2023, the US Department of Justice joined with the Federal Bureau of Investigation (FBI) and the US Department of Health and Human Services Office of Inspector General (HHS-OIG) to launch a multi-state law enforcement action to apprehend individuals involved in this fraudulent nursing degree scheme. They named their enforcement action “Operation Nightingale,” after Florence Nightingale, the founder of modern nursing. The NCSBN has also been working closely with authorities to identify and monitor individuals who purchased fake degrees.

Fernando Porras, an assistant special agent with the OIG, leads the oversight investigation. In an interview with Yahoo News, Porrass revealed that undercover agents were used to investigate the fake degree claims. Porras said, “We sent in — on several occasions — undercover agents to purchase these degrees as they were explained to us, and they were able to purchase the degrees having no medical background or having taken any course. They just paid the amount.” The scheme was first brought to authorities’ attention when a Florida state audit identified poor NCLEX passing rates at the three aforementioned nursing programs.

But according to Porras, these schools were actually once “legitimate” institutions. “They were certified by the state of Florida to provide nursing degrees, and they got to the point that their passing rate was dismal, so they were put on probation,” said Porras. “Shortly after, their certification was revoked. So once they were revoked, and they could no longer issue any diplomas, they would back-date the attendance of these students. So, let’s say they were revoked in 2019; then they would issue the certificate and the diploma as if the student had attended between 2016 and 2017.”

The enforcement action has created a ripple effect throughout the country, with many states handling the situation differently. State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. The Texas Board of Nursing announced it had filed formal charges against 23 nurses who fraudulently obtained credentials from the schools, and in New York, more than 900 nurses who studied at these Florida-based nursing schools were asked on February 7th to prove their credentials. They were given until February 21 – a mere two weeks – to prove they had met the educational and training requirements to qualify for the NCLEX. According to the New York State Education Department, another 2,400 New Yorkers who enrolled in the delinquent Florida programs had their pending licenses withheld until they, too, could prove they had “met the requirements for acceptable education, examination, and moral character.”

The Operation Nightingale enforcement action has resulted in the execution of search warrants in five states: Delaware, New York, New Jersey, Texas, and Florida. Twenty-five people were charged with criminal wire fraud and wire fraud conspiracy for their involvement in the scheme, and these people could face up to 20 years in jail. Ultimately, the enforcement action speaks to the true purpose of a nursing license: to protect the public from harm by setting minimum qualifications and competencies, thus ensuring people receive care from qualified, licensed individuals.

How to Protect your Organization from Potential Licensure Fraud

Operation Nightingale should urge healthcare organizations and compliance officers to coordinate with HR to ensure their providers hold legitimate credentials. One way to do this is by having HR double-check the education information provided on the employment application to determine whether or not their nurses received diplomas at these delinquent Florida nursing schools. Donna Thiel, Chief Compliance Officer at ProviderTrust, said, “It’s an opportunity to promote partnership between HR and compliance. It’s sitting down with HR, and thinking about your employee population first and foremost. Are you in Florida? What are your pre-hire practices? What type of educational validation have you conducted? If you’re in Florida, you’re at a higher risk but not out of the woods.”

Michael Rosen, Co-Founder of ProviderTrust, added, “Having spent 15 years in the background screening industry, this is really a background screening issue. From a pre-employment side, I would suggest that companies go back and look and see whether or not they have any students or licensed nurses that graduated from those three programs. If so, that’s the first circumspect clue to delve deeper then and see whether or not [their license] has been revoked.”

As of March 2023, eight states have taken disciplinary action against individuals involved in the scheme, 13 states have confirmed ongoing investigations, and only two states (Wyoming and Arkansas) have reported no nurses in their state were allegedly involved. Thiel said about these multistate motions, “As an HR professional or a compliance professional, that’s enough alarm for me to know that I can’t just rely on, ‘Hey, I’m not in Florida, so I don’t have to worry about this.’ These nurses have crossed borders.”

In addition to having HR departments conduct background screens and verify that employed nurses have not received their degrees and licenses from any of the now-shuttered Florida nursing programs, compliance officers should consider increasing the frequency of license verification checks. ProviderTrust recommends conducting license verification monthly. By doing so, organizations can catch licensure status changes that may result from the Operation Nightingale enforcement action. These status changes will help organizations identify which individuals may be at risk of their license becoming invalid due to the government investigation.

Although the Operation Nightingale enforcement action has uncovered a harsh reality – that thousands of unqualified nursing students gained licensure and employment by simply buying their credentials – the formidable investigation of dozens of subsequent disciplinary actions demonstrates a nationwide commitment to upholding safety and legitimacy within the healthcare space. Healthcare organizations, HR departments, and compliance officers are now working together to ensure their providers’ education and training are legitimate, and the investigation has increased public awareness of the importance of valid, lawful credentials. At ProviderTrust, we hope this will lead to a safer and more trustworthy future for the healthcare industry.

Simplify your License and Credential Verification Process

About ProviderTrust

ProviderTrust simplifies and automates the license monitoring process for healthcare’s top HR and compliance teams. ProviderTrust provides daily exact-match results from the primary source. This allows healthcare organizations to focus on their patients, with in-house and contracted staff, while ensuring credentials are always in good standing.
Michael Rosen, Esq.

A. Michael Rosen, Esq.

Partner, Co-founder, ProviderTrust

Michael is an expert in designing and developing innovative tools in risk management and compliance industries that tackle real-world problems that make healthcare smarter and safer. He brings over 25 years of experience in founding and leading service-oriented businesses and is an active speaker and presenter at compliance, legal, and risk conferences.

Donna Thiel
Donna Thiel

Chief Compliance Officer, ProviderTrust

Donna brings over 30 years of experience in the long-term care industry to lead the vision, execution, and strategy of our compliance vertical and operation. She is an active speaker on compliance strategy and an industry thought leader.

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