The Impostor Nurse Crisis: When Speed and Safety Collide

The patient census doesn't decrease just because you're short-staffed.

When a cardiac unit is running at 87% capacity on Thursday and you have a qualified candidate who can start Monday, every day of delay feels like an additional patient safety risk. Background checks, license verifications, and sanction screenings all take time. And when orientation is already scheduled, the pressure to accept a candidate's documentation at face value becomes almost irresistible.

"I think corners start to get cut for the sake of speed," says Matt Jaye, senior vice president of sales at Cisive, who has seen this dynamic play out at healthcare organizations over the past 25 years. "And as a result, you start to see things like this."

Impostor nurses. Fraudulent credentials. Nurses who allegedly used 20 aliases to work at nine Pennsylvania facilities. Providers accused of treating nearly 5,000 patients in Florida using a stolen license. The 7,600 fake nursing diplomas that federal investigators traced to three Florida schools in Operation Nightingale.

The impostor nurse problem isn't new. But the conditions that allow it to thrive—including staffing desperation and fragmented screening technology—have converged into what experts now recognize as a systems failure, not just individual bad actors.

A Perfect Storm of Pressure and Opportunity

As a veteran of the background screening industry, Matt knows that healthcare fraud isn’t new. What's changed are the scale and the conditions. Three forces have converged:

1. Dire staffing shortages. The post-pandemic nursing shortage fundamentally changed how healthcare organizations compete for talent. Three years ago, a top-10 health system “would have a four-page questionnaire," says Joe DeSanzo, senior vice president of sales at Cisive PreCheck. "Now they just want your first name and cell phone number."
2. Technology enabling fraud at scale. The same digital tools that should make verification easier also make document forgery more accessible. "Through technology and data mining, these bad actors are put in a position where they can do this at greater scale," Matt notes. "And there's a pretty significant economic payoff. Healthcare jobs are coveted. They're highly paid."
3. Fragmented verification systems. Thousands of healthcare licensing variants exist in the U.S. Some are automated, while others require manual verification. Compact licenses, meanwhile, allow nurses to practice across state lines under reciprocity rules that vary by jurisdiction. Travel nursing is another complicating factor, recruiting out-of-state professionals who may hold licenses in multiple locations.

"It's not just this unified agreement or license across all 50 states," Joe explains. "Understanding where someone's primary license is, where their reciprocity is, what is accepted by the accrediting bodies, and understanding those requirements is really the most fundamental part."

Here is a common scenario: A nurse is sanctioned in Texas for a serious violation. That nurse moves to Pennsylvania and applies for work using a reciprocal license. If the hiring organization only verifies the Pennsylvania license status, they'll miss the Texas sanction entirely.

"These folks are becoming smarter," Joe says. "They understand where the loopholes exist."

Beyond licensure lies additional verification challenges, including falsified immunization records, forged employment histories, and manipulated transcripts. "There's a whole ecosystem of fraud going on out there. It's not just limited to licensing,” Matt says.

The Hidden Business Costs of Imposter Nurses

When healthcare leaders think about impostor nurses, patient safety rightfully comes first. But employers also face significant business implications.

Medicare and Medicaid Clawbacks

When an impostor nurse is discovered, federal programs and financial institutions can halt future payments, but they can also demand refunds for services provided, sometimes going back years.

"Every payment issued since that time, we're now flying back," Matt explains. "You can imagine what that looks like, given the cost of healthcare. It's really, really significant."

For example, an impostor nurse works full time for two years treating Medicare and Medicaid patients, and the organization billed $500,000 for their services. All of that revenue could be clawed back.

Accreditation Penalties

Organizations like the Joint Commission and National Committee for Quality Assurance (NCQA) regularly audit credentialing practices.

"If they see that something's out of line, that can cost you from being a four-star facility," Matt says.

Losing accreditation status can trigger remediation plans—including more frequent audits, operational constraints, and, in severe cases, losing the privilege of serving certain patient populations.

Reputational Damage in the Age of Social Media

Allowing imposter nurses to work in your organization creates reputational damage that evokes public displeasure, especially when amplified online.

Jennifer Mensik Kennedy, president of the American Nurses Association, captured the emotional impact: "You hear about those cases on social media and your heart sinks. … it shakes the trust of people."

In healthcare, trust is currency. Losing that trust affects everything from patient choice to physician recruitment to insurance contracting.

Where the Breakdown Happens

Most individuals posing as licensed nurses should be detected during initial screening, at least when organizations conduct comprehensive verification procedures. But that's where stressed-out HR teams and organizations can be vulnerable.

"In the haste and the pressure that these HR leaders and their teams are faced with, sometimes there's an inclination to say, 'Well, you know, this is taking two days, and let me just get the copy from the candidate, and we'll accept that at face value,'" Matt says.

Watch for these warning signs:

• • Name mismatches are explained away. In one recent case, a candidate's name didn't match their license. The explanation? "I got married." The hiring organization accepted this without requesting a marriage license.
  • Missing documentation is rationalized. When a candidate can't provide verification for a credential, there's always a reason: The school is closed. The license board isn't responding. The previous employer won't confirm. Impostor nurses count on hiring teams giving them the benefit of the doubt because of time pressure.
  • Gaps in verification processes. Many organizations use multiple vendors across verification components. They may use one for background checks, another for license verification, and another for sanction screening. "Traditionally, our space in background screening and credentialing has been siloed and bifurcated," Joe notes. That fragmentation creates information gaps, while manual handoffs create opportunities for human error.

Even organizations that conduct thorough initial screening often neglect continuous monitoring. A nursing license verified on day one might expire six months later, while a clean initial background check doesn't account for criminal charges filed after hire.

"If you don't have any sort of continuous monitoring process in place, you may be taking that employee's word for it," Matt explains. "That's not good enough. That's where fraud can come in. It's easy to manipulate documents. That's where you really need actual primary source verification."

The False Choice: Speed vs. Thoroughness

There’s a faulty assumption too many healthcare leaders make: Thoroughness takes time, and so we have to accept some risk to hire quickly.

"I think historically, that had been the case," Matt acknowledges. "But we're in an environment now where you don't have to choose between good or fast."

The difference is infrastructure. Organizations that treat background screening and credentialing as isolated, vendor-managed processes will always face the speed/thoroughness dilemma. But organizations that build verification into their core hiring systems can achieve both.

"It really is thinking differently and working with a partner that understands the full life cycle in healthcare," Joe explains. "There are very complex and compliance-driven processes, but there are also opportunities to drive significant interoperability."

The key is integration. When your background screening partner's data lives in your applicant tracking system, your HR information system, and your scheduling software, verification doesn't slow down hiring. It becomes part of the workflow.

PreCheck's integrated platform illustrates this solution. Organizations, on average, see a 31.8% reduction in time to fill while maintaining 99.9994% background check accuracy. That's solving the right problem correctly.

"We have to get our data to live in their system of record," Joe says. "The challenge is not sacrificing the efficacy of the solutions along the way."

What Healthcare Leaders Should Actually Do

What are the next steps for organizations worried about their vulnerability? Here are six steps to take with every potential hire.

• • Start with "why." Don't wait for an incident to expose vulnerabilities. Undertake a comprehensive review with an expert, Joe recommends. "Ask yourself, why are we doing it this way?" Many organizations haven’t questioned or updated their credentialing practices, even as accreditation standards have evolved.
  • Conduct a risk assessment. This review should document which screenings occur, whether they meet your accrediting body's requirements, where manual handoffs create potential failure points, and how you handle compact licenses and reciprocity. Bring in a partner that “really knows what it's like from your side of the table and can say, 'Here are the areas of vulnerability. This is what we'd recommend to seal that up,'" Matt suggests.
  • Don't ignore red flags. This means "really trusting the pros, effectively vetting candidates, not taking shortcuts to get a candidate through," Matt says. When something seems off, resist the temptation to rationalize it under time pressure.
  • Verify at the source. Candidate-provided documents are insufficient. "That's where you really need actual primary source verification," Matt says. For licenses, check directly with the board of nursing, or work with a partner who automates primary source verification across thousands of license types. Tools like LicenseManager Pro monitor over 3,000 license types and provide real-time alerts for expirations, board actions, and sanctions.
  • Build continuous monitoring. Initial screening is a snapshot in time. Ongoing monitoring should cover license renewals, board actions, sanctions lists updates, and new criminal charges. "When you're locked in with us, you're on autopilot," Matt explains. "If a flag comes up, the system alerts you."
  • Work with specialists. Matt offers a stark analogy: "If I have a heart problem, I'm not going to a general practitioner. I'm going to a cardiologist. I need somebody who knows this highly specialized space very, very well." Healthcare background screening demands deep expertise in regulatory requirements, licensure complexity, accreditation standards, and continuous monitoring obligations.

Infrastructure, Not Vigilance

Solving the impostor nurse problem isn't about hiring teams working harder or being more suspicious. It's about building the right infrastructure before a crisis forces your hand.

"These are HR and talent acquisition leaders burdened with serious compliance challenges," Joe says. "There's help. The solutions available today weren't available five years ago. We can drive serious automation and efficiency while closing compliance gaps."

Healthcare organizations face legitimate staffing pressure. Patients still need care. But verification isn't a luxury to skip because you're busy. It's essential infrastructure, like fire suppression or infection control.

"Really trusting the pros and relying on the partners that you have that are experts at identifying these things," Matt concludes. "That's the best place to start."

With the right partner, you don't have to choose between speed and safety. You protect patients, protect your organization, and still fill critical roles quickly.

In healthcare, you can't afford to choose. You need both.

Ready to assess your organization's vulnerability to fraud? PreCheck healthcare screening experts can review your current verification processes, identify gaps, and recommend solutions that maintain compliance without slowing hiring. Talk to a compliance expert today.