A 35-year-old Texas resident was arrested and charged with making false statements related to healthcare matters and aggravated identity theft, announced US Attorney Alamdar S. Hamdani on September 11, 2023. The three-count indictment, returned September 6, alleges the defendant impersonated a nurse from January 2017 through December 2019 and performed work she was not qualified to do at multiple home health companies in the Laredo area.
The patients and healthcare providers were part of the federally-funded Medicaid and Medicare programs, according to the charges. The defendant is also alleged to have obtained employment as a nurse trainer in the federally-funded Job Corps program and was assigned to train future nurses.
If convicted, the defendant faces up to five years in federal prison as well as a possible $250,000 maximum fine for each of the false statements charges. She faces an additional two years in prison for aggravated identity theft which must be served consecutively to any other prison term imposed.
Compliance Perspective
Issue
It is a crime to hold oneself out as practicing a health profession, to use as your own the license or registration of another person, or to actually practice nursing without a license. 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 Office of Inspector General’s (OIG) 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 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.*
