2 questions hospitals should be asking amid the nurse degree scheme

A coordinated scheme to sell aspiring nurses fake diplomas and transcripts has allowed more than 2,800 individuals to pass the National Council Licensure Examination without proper training, many of whom went on to gain licensure and employment at healthcare facilities nationwide, federal authorities said. 

The National Council of State Boards of Nursing and its state regulatory bodies have been working closely with state and federal authorities to identify and monitor individuals who allegedly purchased the fake nursing degrees. The Delaware Board of Nursing has annulled the nursing licenses of 26 individuals tied to the scheme, while the Georgia Board of Nursing has asked 22 nurses to voluntarily surrender their licenses. 

However, hospitals should not wait for state and federal investigations to identify these nurses, David Schumacher, former deputy chief of the healthcare fraud unit for the U.S. Attorney's Office for the District of Massachusetts, told Becker's. Mr. Schumacher is now a managing partner and co-chair of the fraud and abuse practice at Hooper Lundy & Bookman's Boston office. 

Below are the two most urgent questions hospital and health system leaders should be asking amid the ongoing investigations, according to Mr. Schumacher. 

1. Are nurses with phony degrees working at my hospital or health system? Chief compliance officers need to immediately do a deep dive of their personnel files to determine whether any of their nurses hold degrees from the three now-shuttered Florida nursing schools involved in the scheme: 

  • Siena College in Lauderhill
  • Palm Beach School of Nursing in West Palm Beach
  • Sacred Heart International Institute in Tamarac

Hospitals and health systems need to "figure out who they have in their midst, do their due diligence, talk to the nurses and take whatever action is appropriate, rather than just wait and hope that this will come out," Mr. Schumacher said. 

2. Will there be any kind of enforcement on the payer side? The largest unanswered question for hospitals and health systems is whether commercial or public payers will seek to recoup payment for services provided by nurses who didn't have sufficient credentials, Mr. Schumacher said.  

Under Medicare's 60-day repayment rule, overpayments and repayment regularly occur based on good faith billing errors. "So the question is will this fall into that category? Will there be aggressive payers?" Mr. Schumacher asked.

Commercial payers could also invoke clauses in their contracts with hospitals and health systems wherein the healthcare organizations agreed to only use appropriately credentialed providers, he added. 

"The hospitals are quite sympathetic here. I'd be shocked if any hospitals knowingly employed nurses, completely aware that they had falsified credentials," Mr. Schumacher said. "If it's the case they in good faith employed nurses who held degrees from these institutions, and it looked to them like they were legitimate institutions … I think they would have good legs to stand on to say there's no basis for recoupment here if they acted on good faith."

However, hospitals do need to show they took immediate steps to remedy the issue if they do identify nurses in their organization with fraudulent degrees. 

"Because if they're continuing to employ them, at this point, they look a bit less sympathetic," Mr. Schumacher said. 

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