September 7, 2016

Healthcare License Fraud: Don’t Get Schooled by a Con

By Michael Rosen, Esq.

In this article we are going to help you identify a fake healthcare license, as well as where and how to verify a license. It may be hard to believe, but sometimes what appears to be a valid document is not. 

Let’s first examine the proper anatomy of these credentials and the governing bodies that can legally issue them.  

If we’re talking about a healthcare entity regulated by a state that requires a license, then the issuing body would be a state licensing board. Each state manages its licenses in different ways and through different departments or boards. Consider a nurse’s license from Tennessee, for example. The Tennessee Department of Health’s Professional Board of Nursing is the issuing body, to be exact. This is the department that issues licenses and the place one can go to verify them. 

Anatomy of a License:

Full Name
License Number
Date of Issuance
Date of Expiration
Department of Health Board Issuing the License
Type of License
Seal of the Department
Signed by Board members

How do people commit license fraud? There are several ways:

  • Obtaining licensure based on fraudulent credentials 
  • Stealing the identity of another
  • Being licensed in one capacity yet altering credentials to practice in another
  • Working off an expired license

How can you identify a fraudulent license? Fortunately, there are several ways:

  • Failure to provide the original license
  • Document is altered, torn, taped, copied, and/or shows creases
  • Non-uniform text or missing dates (such as year of issuance)
  • Inconsistent data (expiration date before issuance date)

The healthcare license verification process involves verifying the expiration date, the license number, the name on the license, the birth date of the license holder, etc. Sometimes, the sanctions on the individual who holds the license are listed on the verification database, but not always. However, you will generally get close to the relevant information needed to verify and monitor for sanctions in the verification process.

Over the past year, 13 nurses had their professional licenses revoked by Massachusetts regulators after they discovered that the nurses had lied about their credentials and in fact did not have degrees or licenses from other states. Five of the nurses had actually been practicing under these false pretences! 

How often should you monitor for this? It is best practice to search monthly for sanctions, disciplinary actions, and status. A license typically expires in a two-year period for most professions. However, it can be sanctioned, revoked, limited, and/or non-renewed. Thus, checking monthly will cover the above risks. 

Remember, a license is a privilege and not a right. It must be earned and maintained. It can also be altered or revoked. There are more than 80 different types of professional healthcare licenses, ranging from that of a nurse aide to that of a board-certified brain surgeon.

Considering that there are 50 states that have licensing boards, there are more than 4,000 primary sources that may need to be checked.

Furthermore, some professions, such as nurses, have a multi-state licensure compact, and thus the address of the person holding the credential is key to which state he/she must have a license before working in another state.

About the Author

Michael Rosen brings more than 25 years of experience in leading risk mitigation-oriented businesses. Rosen co-founded Background America, Inc., and he is currently the co-founder of ProviderTrust, Inc., an exclusion monitoring SAAS company. Rosen graduated from the University of Texas and the University of Memphis Law School. 

Contact the Author 

mrosen@providertrust.com

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