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NPDB Technical Assistance: Fraudulent Nursing Degrees (Operation Nightingale)

State nursing boards across the country have begun taking action against individuals who received fraudulent nursing diplomas and transcripts related to the law enforcement action known as Operation Nightingale. Even though the National Practitioner Data Bank has not changed any policy guidance related to state licensing board actions, the answers to frequently asked questions about this topic are provided below.

Are actions taken against these individuals reportable to the NPDB?

According to NPDB Regulations at 45 CFR §60.9 (a)(1), each state is required to report to the NPDB "Any adverse action taken by the licensing or certification authority of the state as a result of a formal proceeding, including revocation or suspension of a license...reprimand, censure, or probation." By using the term "including," the language makes it clear that an adverse action is not limited to those actions listed in the regulations.

Are voluntary surrenders also reportable?

According to NPDB Regulations at 45 CFR §60.9 (a)(2), each state is required to report "any dismissal or closure of the formal proceeding by reason of the health care practitioner,... surrendering the license,... or leaving the state or jurisdiction."

As explained in the NPDB Guidebook, the surrender of a license, while under investigation or in return for not conducting an investigation, is reportable to the NPDB. This includes those instances where a health care practitioner voluntarily surrenders a license in exchange for a decision by the licensing or certification authority to cease an investigation or similar proceeding, or in return for not conducting an investigation or proceeding, or in lieu of a disciplinary action.

Are summary or emergency suspensions and other nonfinal actions reportable?

As explained in the NPDB Guidebook, the requirements for reporting state licensure and certification actions are not limited to final actions. Interim or nonfinal adverse actions taken by a state licensing or certification authority also must be reported to the NPDB. Examples of such actions include a state licensing board's summary or emergency suspension of a license, or a health care practitioner's voluntary agreement to refrain from practice pending completion of a state licensing board investigation. Once a final action is taken that supersedes or modifies the initial action, the state licensing or certification authority must submit a Revision-to-Action Report.

If a nursing board denies a license to one of these individuals, should that be reported?

As explained in the NPDB Guidebook, state licensing and certification authorities must report to the NPDB denials of initial and renewal applications for licensure if they are adverse actions resulting from formal proceedings. For example, if a state licensing board denies a practitioner's initial licensure application after a formal proceeding because the applicant misrepresented credentials, it is reportable.

However, if an application is rejected as an administrative function for not meeting threshold criteria, and the board takes no adverse or negative action, it is not reportable.

How does the NPDB define a "formal proceeding?"

As explained in the NPDB Guidebook, in the context of state licensure, a formal proceeding is one that is conducted by a state licensing or certification authority that maintains defined rules, policies, or procedures for such a proceeding. The definition of formal proceedings is written broadly to include formal hearings as well as other processes that follow defined rules, policies, or procedures. In determining whether a process meets this definition, the NPDB is only concerned with the presence of defined rules, policies, or procedures and not whether the rules, policies, or procedures have been strictly adhered to.

Should we report these actions to the NPDB in a specific way moving forward?

We suggest the following:

  • Action Codes: As always, you should select one or more Action Codes to accurately reflect the action taken by the Board.
  • Basis for Action Codes: You may select up to 5 Basis for Action codes for each report. As part of your report submission if appropriate, please include the Basis for Action Code E4: "Fraud, Deceit or Material Omission in Obtaining License or Credentials." This code includes intentionally providing false, altered, or omitted documents and information when applying for licensure.
  • Report Narrative: As part of your report submission, please refer to "Operation Nightingale" in the report narrative. This will inform individuals who view the report that the identified individual was associated with this law enforcement effort.

For additional reporting guidance please refer to the NPDB Guidebook - Reporting State Licensure and Certification Actions, the NPDB website, or contact us.

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