Inside healthcare’s imposter problem

Alexis Kayser (Email) – Becker’s Hospital Review

It has been over a year since the FBI and Justice Department disclosed “Operation Nightingale,” which cracked open a fake nursing degree scheme at three now-shuttered schools. More than 7,600 fraudulent diplomas and transcripts were sold to aspiring nurses, who paid $10,000 for the documents — without completing the necessary coursework to graduate.

Omar Pérez Aybar, special agent in charge with HHS’ Office of Inspector General, called it “one of the most brazen schemes [he had] ever seen.” The effects are still felt throughout the nurse licensing process, as questions about some schools’ legitimacy linger. For human resources leaders, the scandal raised questions about hiring practices and, in some cases, the qualifications of those among their ranks.

Operation Nightingale was one of the most widely publicized healthcare imposter cases, but several individual bad actors have also been reported over the past year. In March, a teenager who posed as a PA at two Texas hospitals was sentenced to five years in prison; the same week, a former Iowa hospital administrator pled guilty to identity theft. A Michigan woman currently faces seven years in prison for using another person’s identity to gain employment as a nurse and making false statements related to healthcare matters. A Kansas health system fired its CFO in the fall after discovering that he had changed his name and was actually a convicted felon.

These cases are not extraordinarily common, but they’re also not exceedingly rare. Becker’s connected with four health system human resources chiefs for their takes on the issue.

How concerned should HR leaders be about imposters?

Dallis Howard-Crow wouldn’t say she’s “concerned” about imposters slipping through the cracks — but as chief human resources officer at Aurora, Colo.-based UCHealth, she is “aware.”

Shelley Parn, HR chief at Peoria, Ill.-based OSF Healthcare, feels similarly. She told Becker’s that the issue is not as prevalent as people might think it is, given the high publicity of certain cases. But the health system is “very risk averse,” she said, and takes extra precautions to ensure its bases are covered.

Some leaders believe that the issue is at a tipping point. The rise of artificial intelligence has made it easier for people to fabricate identities, according to Leeann Kaminsky, senior vice president and CHRO at WVU Medicine in Morgantown, W.Va.

“I don’t think anything is failproof,” Ms. Kaminsky said of HR leaders’ efforts. “Unfortunately, we live in a world with bad actors.”

Calvin Allen, executive vice president and HR chief at Children’s Hospital of Philadelphia, shared Ms. Kaminsky’s concerns.

“Bad actors are becoming increasingly sophisticated, especially with social engineering and identity theft, so no one has a 100% airtight system,” Mr. Allen said. “HR professionals can’t solve this issue alone. We need the engaged partnership of hiring leaders and all who are involved in the interview process to be vigilant in the recruiting process.”

How to prevent un(der)qualified hires?

Most HR leaders agreed that their states’ minimum hiring requirements are insufficient filters.

Illinois regulations only require a state background check to hire healthcare workers, but OSF Healthcare has been running federal background checks for the past few years. Sometimes, a licensed healthcare worker will be cited in one state, then apply for jobs in another state. Due to backlogs in state licensure departments, those issues might not show up anywhere but a federal background check.

“I think as HR professionals, we have to think beyond that [state requirement] in today’s society,” Ms. Parn said. “All healthcare organizations should have a very comprehensive compliance approach to licensures: You go above and beyond what the regulations say you have to do.”

In addition to federal background checks, OSF conducts monthly licensure checks (significantly more frequent than the biannual requirement); this way, any disciplinary changes that slipped through the hiring process due to reporting delays can be caught in real time. The system has been able to catch licenses on probation using this method, Ms. Parn said. Bots placed by the system’s analytics division frequently grab and audit the licenses, saving the HR department a significant amount of time and labor.

Patients and employees play a live role in the process, according to Ms. Parn. They can call an “integrity line” to report any issues they see, and the health system has a system specifically for employees to report concerns about a co-worker’s license. OSF Healthcare is “like a small town” with 25,000 employees. Ms. Parn said the lines get occasional use.

UCHealth also requires “intense” background checks, including both universal and Colorado background checks, and employment verification for the past three years. Like Ms. Parn, Ms. Howard-Crow has found that applicants on the cusp of getting fired in other states are more likely to show on the federal checks. Additionally, frequent competency checks are commonplace at UCHealth.

Children’s Hospital of Philadelphia takes extra precautions due to its status as a pediatric provider. Pennsylvania’s child protection law is so strict that the hospital is more thorough than its adult-care counterparts, Mr. Allen said. Formal criminal background, child abuse and FBI checks reveal issues at the local, state and federal levels and are repeated every five years after hire. The hospital formally verifies all required education, licenses and certifications — and participates in an ongoing “list serve” for in- and out-of-state sanctions, which allows any issues with nurses, advanced practice providers and physicians to surface.

At WVU Medicine, extra sets of eyes provide added layers of protection, Ms. Kaminsky said. The system has hired some executives through a search firm and uses a vendor to support its screening process. The HR team keeps an eye on the news — when the nurse degree scheme broke, it conducted an audit to ensure there were no fake diplomas among WVU’s ranks. All were clear.