“Operation Nightingale”: Fraudulent nursing diploma scandal exposes US health care and education crises

Last week, in the final stages of the multiyear federal investigation nicknamed “Operation Nightingale,” 25 people were arrested and charged in connection with the sale of 7,600 fraudulent nursing degrees. 

A nurse administers a COVID-19 test outside the Salt Lake County Health Department, Tuesday, December 20, 2022, in Salt Lake City, Utah. [AP Photo/Rick Bowmer]

The scheme involved the selling of fake nursing diplomas and transcripts obtained from three accredited Florida-based nursing schools—Siena College, Palm Beach School of Nursing and Sacred Heart International Institute—which allowed aspiring Registered Nurses or Licensed Practical Nurses to sit for the board exams and obtain licensure. At this time, it is unclear if there are more people involved in this scandal or if other such fraudulent diploma rings remain to be discovered.

Those charged include administrators of the involved nursing schools and administrators of several test preparation academies across the country that recruited interested parties to purchase the fake diplomas. Charges include wire fraud and conspiracy to commit wire fraud and the defendants face up to 20 years in prison. 

The allegations reflect a deepening crisis in the health care and education systems that the defendants sought to exploit. The health care system in the US is crumbling amidst continued surges of COVID-19 and the mass exodus of nurses and other health care workers who face unsafe and exhausting working conditions. 

At the same time, the increasing expense of higher education tempted workers who wanted to better themselves and their career prospects to engage in illegal activities rather than face a mountain of student debt in becoming a nurse. While the names of those who purchased the fake diplomas have not been released, it has been reported that many were Haitian immigrants living in South Florida. 

Those who purchased the fake diplomas are not currently being charged and individual state nursing boards have been tasked with finding and annulling the licenses in question.

A few states have already annulled fraudulent licenses, including 26 licenses in Delaware and 22 in Georgia. Seventy-seven licenses are under review in Washington state. It has been left to the discretion of the nursing regulatory bodies in affected states to investigate individual cases and take appropriate action in accordance with their state laws and due process. The scandal also calls into question the practices of state nursing boards, which were unable to detect the fraudulent documents for multiple years. 

Between 2016 and 2021, a total of $114 million changed hands in exchange for the fake degrees with “students” paying between $10,000 and $17,000 for the service and never stepping foot in a classroom or clinical setting. Out of the 7,600 degrees sold, only about 2,400 people eventually passed the licensing exam and were eligible for employment in health care facilities.

It has been reported that the nurses with the fake degrees found employment in various settings, including pediatric home care, assisted living facilities and veterans hospitals in several states, including Ohio, New York, New Jersey, Massachusetts, Georgia, Maryland and Texas.

Investigators with the US Department of Health and Human Services–Office of Inspector General (HHS-OIG) were first tipped off to the fraud in 2019 when the state of Maryland reported two Florida business people, Geralda Adrien and Woosvelt Predestin, and their company PowerfulU Health Care Services LLC, which processed applications for buyers through the aforementioned Florida nursing schools and helped buyers coordinate testing preparation and any other requirements needed to sit for the licensing exam.

Adrien and Woosvelt pleaded guilty and were sentenced to 27 months in prison after cooperating with the HHS-OIG investigators to identify other defendants. There are no court dates set for the 25 defendants currently being charged.

State nursing boards and hospital systems have been slow to respond, leaving upwards of several hundred or more licensed nurses in health care who are working illegally with no formal training. There is also no way at present to trace or understand the damage that has already been done by the rogue health care workers. 

Currently, none of the workers who purchased the fraudulent materials are being criminally charged. Many nurses across social media have taken issue with this, concerned that it is a product of hospitals and nursing regulatory boards seeking to avoid liability. A hospital that investigates and admits to employing fake health care workers would likely face costly lawsuits. 

One nurse spoke to a WSWS reporter on Reddit, stating, “We all know why they aren’t going after them. Once they start pulling on threads it will uncover patient harm and (more importantly to them) liability to their precious hospital systems/top donors.” A similar sentiment was echoed by others on a thread related to the diploma scandal. 

This, of course, contrasts with the criminal prosecution by Vanderbilt University Medical Center (VUMC) of RaDonda Vaught in May of last year. Vaught made a medication error that led to the tragic death of one of her patients, Charlene Murphey, in 2017. After first attempting to cover up the incident, VUMC later fired Vaught and took her to court rather than examining the conditions of chronic understaffing and system failures that no doubt led to the incident. 

The case demonstrated the attitude of the health care corporations and the entire capitalist state to health care workers. Charges were brought against Vaught not out of genuine concern for patient safety but rather to protect the reputation and profit interests of the university and medical center.

In the context of the current diploma scandal, hospital systems do not appear to be engaging in a serious investigation or publicly acknowledging the employment of fraudulently licensed nurses. This exposes, yet again, the profit-driven character of the health care system itself, where reputation and finances take top priority over the safety and needs of patients and staff.