A massive, coordinated scheme to sell false and fraudulent nursing degree credentials has been brought down by a joint federal law enforcement operation, Justice Department officials said Wednesday.
As first reported by ABC News, officials said the scheme involved peddling more than $100 million worth of bogus nursing diplomas and transcripts over the course of several years -- fake credentials that were sold to help "thousands of people" take "shortcuts" toward becoming licensed, practicing nurses.
Officials said the forged diplomas and transcripts were sold from what had been accredited schools to aspiring nurses, in order to help candidates bypass the qualifying requirements necessary to sit for the national nursing board exam. Although they still had to take the exam, the bogus credentials allowed them to skip vital steps of the competency and licensure process, officials said -- and once licensed, those individuals were able to find a job in the health care field.
Overall, the conspiracy involved the distribution of over 7,600 fake nursing diplomas and certificates issued by Florida-based nursing programs, according to officials.
"This is probably one of the most brazen schemes that I've seen. And it does shock the mind," Omar Perez Aybar, Special Agent in Charge, U.S. Department of Health and Human Services - Office of Inspector General (HHS-OIG), told ABC News in an exclusive interview.
The sweeping enforcement action spanned five states: Florida, New York, New Jersey, Texas and Delaware, and resulted in more than two dozen criminal wire fraud and wire fraud conspiracy charges against 25 individuals.
We "expect our health care professionals to be who they claim they are. Specifically when we talk about a nurse's education, and credentials - shortcut is not a word we want to use," said U.S. Attorney for the Southern District of Florida Markenzy Lapointe. "When we take an injured son or daughter to a hospital emergency room, we don't expect -- really cannot imagine -- that the licensed practical nurse or registered nurse training our child took a shortcut."
HHS-OIG, the FBI and Justice Department worked jointly on the operation, dubbed "Operation Nightingale," in honor of Florence Nightingale, the founder of modern nursing.
Investigating agents spent weeks combing through upwards of 10,000 records from nursing schools to move the investigation forward. "As we started to poke through them we noticed there were no real courses the individuals took -- it was simply a cash mill," Aybar said.
Nursing candidates who allegedly participated in the scheme would pay as much as $15,000 for the fraudulent diplomas, officials said.
The defendants include "owners, operators and employees" of the schools who "prepared and sold fake nursing school diplomas and transcripts to nursing candidates, knowing that the candidates would use those false documents to one, sit for nursing board examinations, secure nursing licenses, and three ultimately obtain nursing jobs in medical facilities -- not only in Florida, but elsewhere across the country," Lapointe said. All three schools have since closed, according to officials. Additional defendants charged include "recruiters" to bring in would-be buyers.
The alleged scheme enabled these nursing candidates allegedly buying the fake diplomas "to avoid hundreds, if not thousands, of hours of clinical training -- countless hours getting that experience," Lapointe said. "These people didn't go through that. That part was completely skipped."
"For them, it was worth the investment, or the risk," Aybar told ABC News.
For those involved -- "the owners of the nursing schools, certainly the recruiters and, without doubt, the recipients of the transcripts and the nursing diplomas" -- Aybar said, "It was definitely all motivated by greed."
Federal law enforcement officials underscored the high stakes of the scheme, saying that it potentially jeopardized patients' health and safety -- and that standards for safe nursing care cannot be purchased -- only learned.
"What is disturbing about the scheme is the possibility of harm coming to patients under the dubious care of one of these allegedly fraudulent nurses," acting Special Agent in Charge Chad Yarbrough, FBI Miami, said.
In the indictments, federal law enforcement officials alleged that the defendants -- some in leadership roles at nursing schools -- "solicited and recruited individuals who sought nursing credentials to gain employment as Registered Nurses (RN) or Licensed Practical/Vocational Nurses (LPN/VN)," then arranged with co-conspirators "to create and distribute false and fraudulent diplomas and transcripts" to falsely represent that the aspiring nurses had attended the program and had completed the necessary courses to receive a diploma, when "in fact, the aspiring nurses had never actually completed the necessary courses and clinicals."
Aybar said one of the ways officials were alerted to the alleged scheme was when the Florida state auditing process discovered poor passing rates at three nursing schools.
Alleged participants in the scheme backdated the diplomas and transcripts they were selling, to make them appear legitimate, authorities said. Applicants would use those forged diplomas, transcripts and additional records to obtain licensure in various states -- then, once licensed, applicants could then use those fraudulent documents to get nursing jobs "with unwitting health care providers throughout the country," according to officials.
Officials said they had "not learned of, nor uncovered any evidence of patient harm stemming from these individuals potentially providing services to patients" -- but it was the potential for that harm to patients that was precisely the concern.
Aybar said that is why, from the onset of the investigation, authorities have been working with state licensing boards to share as much information as they could, as fast as they could, so the respective boards "can assess what actions to take to prevent these individuals from rendering care."
The action by federal law enforcement comes at a crucial moment in the health care industry, where an existing nurse shortage, exacerbated by the COVID-19 pandemic, has left many nursing staffs spread thin and burnt out.
"I'm confident that there will be a level of accountability that all of these individuals will face," Aybar said.
Defendants in the alleged scheme, if convicted, face a statutory maximum of 20 years in jail for the charges of wire fraud and wire fraud conspiracy, the DOJ said.
Aybar pointed to the pledge of ethics and principles that nurses take, called the "Nightingale Pledge."
"They pledge that they're going to abstain from any deleterious act. They will do all in their power to enhance and honor the profession. Clearly, these individuals did not do that here," he said.
"We understand that this conduct has no reflection on the hard work and dedication that [nurses] put into making this profession honorable, and so thank you for that," Aybar added. "I encourage those of you -- if you're in a setting and you happen to have someone that may not be practicing up to the standards as you understand it, maybe if you see something, say something."
Officials said that at this point it is up to the state licensing boards to push forward with action against those individuals under their purview -- some of whom have been practicing nursing "somewhere in the United States, perhaps currently," Lapointe said.
"We know who they are," Lapointe said.
"Not only is this a public safety issue, but it also tarnishes the reputation of nurses who actually did the hard clinical and coursework required to get licenses and jobs," Lapointe said. "And of course, erodes the centuries-old trust we have built with our country's nurses."
ABC News' Luke Barr contributed to this report.