By Wendy Ruderman

In early November 2022, the FBI alerted Delaware’s Board of Nursing that an owner of four Florida-based schools sold fake college degrees to students who then used the phony credentials to get nursing licenses from states nationwide.

Pamela Zickafoose, executive director of Delaware’s board, said she wasted no time. On Nov. 15, 2022, her board annulled the licenses of 26 nurses who had bought degrees for about $17,000 each. Among the 26 was a registered nurse from Philadelphia who obtained a license to practice in Delaware — and in Pennsylvania, state records show.

Federal authorities say the implicated nurses took a “short cut” to get degrees without taking any classes or completing the required clinical training.

It took Pennsylvania six more months to act. On May 8, Pennsylvania’s Board of Nursing sent a notice to that nurse — and 17 others — saying she had 30 days to contest allegations that she submitted a fraudulent associate’s degree in nursing when she applied to the board for a license in 2018.

Amy Gulli, a spokesperson for the Pennsylvania Department of State, which oversees the nursing board, said the 18 licensees now facing administrative charges “must be given due process.” She declined to say when the FBI first alerted Pennsylvania’s board to the scam, citing a law prohibiting disclosure of “confidential” investigations. She said the state’s investigations generally “take time.”

Federal authorities said they sent a list of implicated nursing students to licensing boards in every state. In early March, New Jersey Attorney General Matthew Platkin announced that its state Board of Nursing revoked the licenses of 20 nurses and nullified temporary licenses issued to 26 others. The state ordered them to immediately stop practicing and required the nurses to tell their employers.

The search for bogus nurses across the country is ongoing. The investigation, dubbed “Operation Nightingale,” after Florence Nightingale, the British nurse credited as the founder of modern nursing, comes as the ranks of hospital nurses remains battered and thinned by COVID-19 and acts of violence against nurses, including at Einstein Medical Center and other hospitals in Philadelphia, are on the rise.

So far, more than two dozen school operators and student recruiters, including two recruiters in South Jersey, have been charged in connection with the alleged distribution of more than 7,600 fake diplomas, netting more than $100 million. If convicted, they face 20 years in federal prison.

A student licensed in Delaware paid $40,000 to a now-closed Florida school for two illegitimate degrees: He used one to apply to Delaware’s board to become a licensed practical nurse, or LPN, and the second degree to move up in stature as a registered nurse, Zickafoose said.

“It’s egregious,” said Zickafoose, a nurse for 42 years with an expertise in vocational education and training. “Nursing education is very, very hard, and it’s that way for a purpose, because we are caring for people’s lives.” In recent months, Delaware has annulled an additional nine nursing licenses, bringing the tally to 35, Zickafoose said.

In Pennsylvania, for now, the 18 people — all registered nurses, or RNs — hold “active” licenses as of May 26. None of the 18 has a history of disciplinary action, according to a review of the state’s licensure database.

Reached by phone last week, Olasumbo Mary Akinmusire, the Philadelphia-based nurse whose license was annulled in Delaware, said she planned to fight Pennsylvania’s administrative charges. She declined to answer additional questions, including where she was employed, saying she was busy at work “taking care of a patient.”

“That’s scary,” said Wayne Reich Jr., chief executive director of the Pennsylvania State Nurses Association, an advocacy group with 3,500 members out of about 230,000 registered nurses statewide.

“It’s a fine line. You want to give an individual due process, but that’s an additional 30 days someone who may not have legally obtained a license is still practicing in the state,” Reich said.

To date, there have been no reports of harm to a patient by an unqualified nurse, said Fernando Porras, a Miami-based assistant special agent with the Office of Inspector General-U.S. Department of Health and Human Services, which partnered with the FBI to investigate.

`Are you here for a degree?’

Porras said the investigation began in 2019 when an informant told the FBI’s Baltimore field office that a recruiter from nearby Laurel, Md., offered to provide a diploma and transcript from a Florida nursing school for about $17,000.

The price included tutoring to sit for the nurse licensing exam, without the need to take a single class or any clinical training.

The tip led investigators to a Haiti-born nurse and entrepreneur, Johanah Napoleon, who ran four Florida schools. Porras said undercover agents walked into three schools and purchased degrees “having no experience whatsoever.” In one case, Porras said, a school official greeted the agent with, “Hi, are you here for a degree?”

“It’s just mind-boggling,” said Porras last week. “This is a case that resonates. It hits home. It can affect any one of us. We have loved ones who are treated in the health-care space all the time and you wonder, is the person who is attending to mom and dad or a grandparent, are they properly trained?”

The prices for the fake diplomas, transcripts and exam tutoring, on average, ranged from $15,000 for a LPN and $17,000 for RN, though prices and deals varied, Porras said.

“There wasn’t a menu where you would order and say, `Let me have two degrees with a side of fries,’” Porras said.

Getting a nursing license is a rigorous process. First, a person must obtain either a diploma, an associate’s degree or a bachelor’s of science in nursing. The education involves hours of hands-on clinical training. Upon graduation, the would-be nurse must take and pass the National Council Licensure Exam (NCLEX), and then apply to a state board for a license.

Of the 7,600 students who allegedly obtained fake diplomas, about 37%, or 2,800, passed the exam and obtained licenses, Porras said.

“Although it’s scary to think that any one of them passed, it was a smaller percentage,” Porras said. “A lot of them just gave up after trying and trying and trying. They paid that $17,000 in vain.”

Many of the students came from Caribbean or Africa countries and had worked in the nursing field in their country of origin. Some struggled with language skills or couldn’t afford the time needed to successfully complete legitimate nursing programs in the United States, he said.

Backdated phony degrees

No students have been criminally charged in “Operation Nightingale.” If found to have submitted bogus degrees and transcripts, Pennsylvania’s board can suspend, revoke or restrict their license and impose a civil penalty. Of the 18 registered nurses facing scrutiny, six currently hold temporary licensing permits.

Federal prosecutors have charged 27 school operators and recruiters, including Stanton Witherspoon of Burlington County. Authorities allege that Witherspoon, a part-owner of now-closed Siena College of Health in Broward County, Fla., also helped orchestrate fraudulent diplomas and transcripts from that school. He founded the Nursing Education Resource Center, a Delaware limited liability company, and recruited students to buy phony credentials, steering them to Siena College, authorities allege.

Witherspoon’s lawyer did not return a phone call and an email. A reporter knocked on the door of Witherspoon’s Burlington Township home. A woman who answered the door said he was unavailable. He pleaded not guilty to wire fraud charges in February. He reportedly owns media outlets in the West African country of Liberia and hosts Spoon TV Live, a social media talk show.

Witherspoon was allegedly part of a network of recruiters in New Jersey, Delaware, Texas, Maryland, New York and Florida who funneled students to now-closed Florida schools and got a financial cut. School operators such as Johanah Napoleon, of West Palm Beach, told authorities that her schools churned out thousands of fake diplomas and transcripts. Napoleon’s lawyer said he was out of the country and unavailable to comment, and efforts to reach Napoleon were unsuccessful.

In November 2022, Napoleon pleaded guilty to conspiracy to commit health-care and wire fraud. As part of a plea agreement, in a sworn affidavit, she gave investigators a list of 4,989 students who “did not complete the required program hours and clinical training necessary to obtain either a practical nursing diploma and transcript or a nursing associate in science degree and transcript,” criminal court records show.

All 18 of the licensees under scrutiny by Pennsylvania’s nursing board were on that list. In their applications, they submitted degrees and transcripts from one of two schools run by Napoleon: Med-Life Institute-West Palm Beach or Palm Beach School of Nursing, a review found.

Florida’s Board of Nursing terminated the program at Palm Beach School of Nursing in June 2017, prohibiting administrators from enrolling new students, because of low scores on the NCLEX exam. The state allowed students enrolled before June 2017 to finish out the program. As part of the scam, Porras said, the degrees and transcripts were often backdated.

“It was amazing because it was so blatant,” Porras said. “They would write a check in March 2020 for a diploma that they received in March 2016.”

By purchasing a degree, those licensed in Pennsylvania could expect to earn an average annual salary of $51,051 as a LPN and $76,000 as a RN.

It falls on Pennsylvania’s licensing board to verify the school’s status when licensing nurses educated out of state.

But in at least one of the 18 cases, an applicant from Upper Darby, Delaware County, submitted paperwork stating she enrolled in Palm Beach School of Nursing in January 2019 and graduated in December 2019, and the Pennsylvania Board of Nursing approved her registered nurse license in September 2020. Her license remains active, records show.

The school had closed to new students in June 2017.