In spring 2019, a curious piece of information landed at the FBI's Baltimore field office. An informant said that for about $17,000, a recruiter in nearby Laurel, Md., had offered to provide a diploma and a fake transcript from a Florida nursing school, along with tutoring for the nurse licensing exam - without the need to actually take courses or receive clinical training.
That tip has mushroomed into an ongoing search for bogus nurses that spans all 50 states, D.C., Canada and parts of the Caribbean. It has resulted in the indictments of 25 people on wire fraud charges and a continued investigation of additional schools that may be offering the same fraudulent arrangement. Ten people have reached plea agreements with prosecutors.
About 2,800 people who bought credentials without attending classes from three unaccredited schools passed the National Council Licensure Examination and presumably have used that shortcut to find work or better jobs in the health-care industry, said Fernando Porras, assistant special agent in charge of the Miami office of the inspector general for the Department of Health and Human Services.
Those names have been turned over to 56 state nursing boards - some states have more than one board - in an effort to find the people with fraudulent credentials, Porras said.
So far, there have been no reports of harm to a patient by an unqualified nurse, according to Porras and the National Council of State Boards of Nursing.
"There's a lot of safeguards in the program," Porras said, noting that registered nurses, licensed practical nurses and others can take jobs in a variety of health-care settings beyond hospitals.
"They get a probationary period," Porras said. "Once they see the nurse can't perform a simple medical task, they're kind of let go."
Still, Porras said, the presence of nurses who might not even know how to insert an intravenous line or calculate drug doses "affects everyone," including law enforcement agents conducting the investigation. "Every family member. Every agent has someone that could be in the hospital, receiving treatment."
The pandemic delayed the investigation after the original tip and plea bargain, but the probe intensified in 2021. The scheme, which has received extensive media attention across the United States, was concentrated in Florida, Maryland, New Jersey, New York, Pennsylvania and Texas. Dawn Kappel, a spokeswoman for the National Council of State Boards of Nursing, said in an emailed statement that not every state had nurses who obtained fraudulent credentials. States that were involved are still working to identify unqualified nurses, she said.
In January, federal authorities announced the indictments of 25 recruiters and school officials in connection with the alleged distribution of more than 7,600 fake diplomas by Siena College in Broward County, Fla.; Palm Beach School of Nursing in Palm Beach County, Fla.; and Sacred Heart International Institute in Broward County.
The schools, which are now closed, were once legitimate nursing schools but lost accreditation because their students had very low rates of passing the licensure exam before the schools turned to selling diplomas, Porras said.
The investigation was dubbed "Operation Nightingale," after Florence Nightingale, the British nurse credited as the founder of modern nursing.
Defendants face as many as 20 years in prison. The nurses who purchased diplomas so far have not been targeted for criminal charges, Porras said, as authorities focus on prosecuting those who ran the scheme and finding unqualified nurses. Future disciplinary action for students is possible, however, he said.
The indictments allege that from 2016 to 2021, a network of recruiters in Florida, New Jersey, New York and Texas funneled recruits to the three Florida schools, which - for payments of as much as $17,000 - provided fake diplomas and transcripts that allowed people to sit for the nurse licensing exam, according to court documents and Porras. The recruiters also tutored the students to help them pass the national exam. About 37 percent succeeded, Porras said.
Each recruitment network generally sent students to a particular school, according to the court documents. In the Siena College network, one of the recruiters, Stanton Witherspoon of Burlington County, N.J., was also half-owner of the school. The alleged participants face wire fraud charges for their parts in the scheme.
Witherspoon's attorney did not respond to an email seeking comment.
J. Samantha Vacciana, attorney for Gail Russ, who is listed in the indictment as the registrar of the Palm Beach School of Nursing, said Russ is innocent and looking forward to her day in court.
Tama Kudman, attorney for Charles Etienne, who is listed in the indictment as president of Sacred Heart, declined to comment.
Etienne is one of 10 people who have reached plea agreements with prosecutors, including two who cooperated with the investigation after taking plea deals in 2019, according to the Miami Herald. Five people entered their guilty pleas in federal court in Fort Lauderdale on Wednesday.
They worked for the Palm Beach School of Nursing or outfits that provided licensing preparation services for students from the bogus nursing schools.
Porras said the investigation is continuing into whether additional schools participated in similar schemes.
