A 35-year-old Texas woman has pleaded guilty to making false statements related to healthcare matters, announced US Attorney Alamdar S. Hamdani on January 3, 2023.
The defendant admitted that from January 2017 through December 2019, she impersonated a nurse and performed work she was not licensed to do at multiple hospitals and home health companies in the Laredo area. These healthcare providers hired the defendant after she fraudulently presented a nursing license of another individual. The patients and healthcare providers were part of the federally funded Medicaid and Medicare programs.
The defendant also obtained employment as a nurse trainer in the federally funded Job Corps program and was assigned to train future nurses. In total, she received $52,241.66 in compensation for working as a licensed nurse when she was not licensed to do so.
US District Judge Marina Garcia Marmolejo accepted the plea and has set sentencing for April 9. At that hearing, the defendant faces up to five years in federal prison and a possible $250,000 fine.
Compliance Perspective
Issue
It is illegal to practice a health profession without a license or to use someone else’s license. Healthcare facilities that receive government funds are required to conduct comprehensive background checks on all employees. Before hiring, a criminal background check, sex offender registry search, identification verification, past employment history, education verification, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) check must be completed. For positions that require certifications or licenses, verification of these credentials must be conducted and documented in the individual’s personnel file. After hire, databases must be 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 since the last check. 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 and monitoring the OIG’s LEIE. 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 and that OIG LEIE checks are routinely conducted. In addition to background and licensure/certification checks, observe for the following: altered or forged driver’s license or insurance card; ID photo doesn’t match; physical description doesn’t match appearance; signature doesn’t match; inconsistent information between forms of ID and Company records; invalid social security number; address does not exist, is a PO Box, or does not match existing records; phone number is invalid, a pager, or an answering machine; failure to provide identifying information; inconsistent personal information compared to the Company record; and/or SSN is the same as provided by another Company individual. 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.*
