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License By Fraud

State boards will be watching healthcare provider license applications for fraud.

Healthcare providers seeking licensure by reciprocity should expect their applications to receive increased scrutiny by the licensing board based upon the recent events in Massachusetts.  The State of Massachusetts
Board of Registration in Nursing recently discovered more than a dozen nursing licenses were obtained by fraud.  The licenses were obtained by submitting fraudulent documents showing the individuals were licensed as nurses in other states.  The Board revoked or suspended the licenses of those individuals.  All of the applications sought licensure in Massachusetts through reciprocity. 

Most states offer licensure by reciprocity to healthcare providers that are licensed in other jurisdictions. Licensure by reciprocity allows a healthcare provider to forgo retaking examinations when seeking a license in a new jurisdiction.  The normal process for licensure by reciprocity is for the board staff, or an outside contractor, to review the applications, verify the information, and then make recommendations to the board.  The board then acts upon the recommendations. 

The investigation in Massachusetts revealed that four of the applications were submitted with forged documents purportedly from the Hawaii Board of Nursing, three had forged documents claiming the applicants were licensed in Alabama, and three had forged documents showing they were licensed in Oklahoma.  It appears the process of vetting these candidates failed in the verification of the credentials.

The Massachusetts Board engaged Professional Credential Services of Nashville as outside contractor to review the applications and verify the information submitted.  Professional Credential Services is a contractor for numerous boards, and those boards are also reviewing the applications previously processed by PCS.

The Massachusetts Board is not the first state board to discover numerous licenses were issued based upon fraudulent information.  Several years ago, the Florida Board of Massage Therapy discovered that a corrupt employee of a legitimate college with a legitimate massage therapy program had been taking cash payments from applicants, and forging transcripts used to obtain massage therapy licenses.  Some of the applicants actually had the required education and training necessary to become licensed, but the corrupt employee embezzled their payments without submitting their paperwork through the college.

The investigation in Florida eventually led to the corrupt employee in part due to facts common to all the cases.  The fraudulent licenses discovered in Massachusetts also have some common elements that could indicate a single individual, or a small group of individuals, is responsible for all the fraudulent applications.

All the individuals that obtained fraudulent nursing licenses in Massachusetts were actually practicing as nurses in some capacity prior to the recent action by the Massachusetts Board.  The employers of those individuals are obligated to verify the licenses of their employees, but they are not are not expected to reexamine the complete application process of the licensing board to ensure it fulfilled its obligations.  Still, the employers could experience some consequences as a result of employing unlicensed individuals.

The fraudulent applications encountered by the Massachusetts Board are not the most common type of fraudulent application encountered by most licensing boards.  The most common type of fraudulent conduct concerning applications is misrepresentation, usually by deliberate failure to disclose negative information.  Applicants should consider all the questions on an application carefully and err on the side of disclosure.  I frequently advise clients that in questionable situations answer the question no, but still provide an explanation of the questionable situation.  Most applications only require explanations of yes responses, but that does not prohibit an applicant from providing an explanation of a negative response.  A carefully drafted explanation of a negative response can prevent a later allegation that the applicant attempted to obtain a license by fraud or misrepresentation. 

Healthcare providers should expect their licensing boards to reexamine their verification processes for applications.  Applicants seeking their first license, or seeking a license through reciprocity, should expect their submissions to be carefully examined and all the information included in the application verified. 

Michael L. Smith, JD, RRT is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla.  This article is for general information only and is not a substitute for formal legal advice.

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