The US Attorney for the Western District of Michigan announced on November 7, 2023, that a 49-year-old woman had pleaded guilty to using the identity of another person to obtain employment as a licensed registered nurse and to making false statements relating to healthcare matters.
The defendant pleaded guilty to two federal crimes: making a false statement in a medical record affecting a healthcare benefit program and aggravated identity theft. The healthcare fraud charge is punishable by up to five years in prison. The aggravated identity theft charge carries a mandatory two years in prison, which must be served consecutively (after) any prison sentence imposed for the healthcare fraud charge. The Court has not yet scheduled the defendant’s sentencing date.
According to court documents, the defendant falsely represented that she was a licensed registered nurse and had completed a Bachelor of Science degree in nursing when she applied for a job at a nursing home. When transmitting her application to the prospective employer over the internet through Indeed.com, the defendant used the means of identification of someone that she knew to be an actual licensed registered nurse in the state of Michigan.
After obtaining employment as a nurse, the defendant evaluated and assessed elderly nursing home residents and falsely signed electronic medical records as a licensed registered nurse. These false statements were related to Medicare, because the nursing home relied on the defendant’s status as a licensed registered nurse to meet certain Medicare regulations for participation in and billing of Medicare.
“Today’s guilty plea underscores the significance and severity of the defendant’s conduct, particularly as it relates to her involvement in the submission of false documentation related to her purported nursing training and state licensure, as well as further false statements connected to her employment as a nurse in a skilled nursing facility,” said Mario M. Pinto, Special Agent in Charge of the US Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG is committed to working together with our law enforcement partners to protect beneficiaries of our federal healthcare programs.”
Compliance Perspective
Issue
Healthcare settings are required to conduct extensive background checks on all employees. These should be comprehensive in order to ensure that each potential employee is qualified and permitted to be employed in a healthcare facility that receives government funds. Before an employee is officially hired into a position, a criminal background check and sex offender registry search must be completed, and the individual must be cleared in the databases. Additionally, an identification verification check, past employment history, education verification, and the OIG’s List of Excluded Individuals and Entities (LEIE) check must be completed for all employment candidates. For positions that need certifications or licenses, verification of these credentials must be conducted and documented in the individual’s personnel file. After hire, it is essential that the databases are continually monitored to ensure that no current employee has recently been placed on an exclusion list or had a license or certification suspended or revoked. Routine monitoring will ensure that employees are legally permitted to practice healthcare in your facility.
Discussion Points
- Review policies and procedures for verifying the status of professional licenses. Update as necessary.
- Train appropriate staff to follow protocols for verification of licenses and certifications of employees at the time of hire and on an ongoing basis to ensure that those licenses remain up to date and are unencumbered. Ensure that training is provided to licensed personnel about their responsibility to maintain an active license and to notify administration should their license be suspended, expire, or if they are added to the OIG’s LEIE. Document that these trainings occurred, and file the signed documents in each employee’s education file.
- Periodically audit to verify that the licensing and certifications of employees are valid and up to date. Immediately address any negative findings.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
