When Kim Danehower, corporate compliance officer at Baptist Memorial Health Care Corp. in Nashville, Tennessee, read about Operation Nightingale—a Department of Justice-HHS Office of Inspector General enforcement action that exposed the sale of 7,600 fake nursing diplomas and transcripts—her heart sank.^[1] More than a third of the people who bought their degrees passed their licensing exams and were licensed as registered nurses (RNs) or licensed practical nurses (LPNs), with grave implications for patient safety and risk management at the facilities where they work. Danehower and other compliance professionals are facing both the urgency of determining whether any of the nurses with ill-gotten licenses are employed at their facilities and a forward-looking review of the way they vet RNs and LPNs.

“That is horrifying,” she said. “We are trying to figure it out. It’s a work in progress.” So far, Danehower has received a bit of welcome news from Arkansas, one of the three states in which her health system operates: none of the nurses who bought fraudulent degrees have Arkansas licenses, according to the state nursing board. She’s still awaiting word from the two other states, Tennessee and Mississippi. Whatever happens with these nurses, this mess is an alert “to shore up processes and work closely with human resources and employment services” to have a good understanding of how credentialing works and to audit and monitor it. “We have rallied the troops and made sure the C-Suite knows,” Danehower said. But there’s still the question of traveling nurses from staffing agencies. “We don’t have complete control over validation,” she noted.

According to the U.S. Attorney’s Office for the Southern District of Florida, 25 people have been charged with wire fraud in connection with an alleged scheme to sell fraudulent nursing degrees and transcripts from three accredited Florida-based nursing schools to people in search of nursing licenses and jobs as RNs and LPNs/licensed vocational nurses (LVNs). More than 7,600 RN and LPN/LVN phony diplomas were issued by the now-defunct nursing schools: Siena College, the Palm Beach School of Nursing and Sacred Heart International Institute. Thirty-seven percent of the nursing-school graduates—2,812—passed their state licensing exams and were licensed.