By Kimberly Marselas

A New Mexico woman indicted on charges of identity theft, abuse of a resident and 32 other counts last week is the latest example of a fake nurse eluding systems meant to protect nursing home patients and providers from impostors.

At a time when credentials may be easier than ever to fake, legal experts say comprehensive new hire screenings could be the difference between compliant, quality care and high-risk, potentially deadly interactions.

Three notable factors, however, stand in the way: “nebulous” federal standards, variances in state background-check systems; and the fact that those systems look for criminality rather than fraudulent documents.

“No process is going to be perfect,” warned Alice Harris, a shareholder in Maynard Nexsen’s Columbia, SC, office.

“The goal is to have a robust background check process as people come into the facility and to periodically rerun that check,” she said. “It’s very possible a determined impostor could get past you. If that happens, you have a ready defense and that you did everything that you could to prevent it.”

With the advent of AI, the threat of impostors is “only going to get worse,” Harris added.

In New Mexico, the attorney general’s office has accused Margarita Gonzalez of assuming the identities of nurses in Texas to land jobs at four nursing facilities and illegally provide care to patients in 2024 and 2025.

Eagle-eyes avert disaster

After a botched — and potentially deadly — insulin dosage was averted by a supervising nurse, Gonzalez was investigated and charged with nursing without a license, distribution of controlled substances to minor patients, and fraud totaling over $25,000.

If convicted on all counts, she could face up to 100 years in prison. The potentially lethal insulin dose Gonzalez planned to administer was stopped by an orientation nurse who noticed her error, officials said.

Officials said she possesses no legitimate nursing license or credentials. The indictment also indicated the suspect used licenses linked to one or more individuals with similar names.

The providers Gonzalez duped were not charged in the case, and neither a state Department of Justice press release nor a charging document indicated whether each fulfilled its duties to run a Centers for Medicare & Medicaid Services-required background check.

The potentially lethal insulin dose Gonzalez planned to administer was stopped by an orientation nurse who noticed her error, officials said.

Gaines Brake, an attorney with Maynard Nexsen in Birmingham, AL, questioned how the impostor eluded a fingerprinting requirement that covers new nursing home hires in the state. It may have come down to the fact that the name of the job applicant and the actual license holder were so similar, he and Harris said.

“This shows us how important it is to verify someone’s identification,” Brake said. “All of the requirements that we’re talking about, whether they’re state or CMS, are looking for criminal history of abuse, exploitation, neglect — crimes. We have to think as facilities and providers that we’re actually talking to the person that we think we’re talking to.”

Generally, CMS prohibits nursing homes from hiring direct care staff with a criminal history of abuse, neglect, exploitation, misappropriation of property, or similar complaints found in a state nurse aide registry or state licensing disciplinary action. But how facilities check for those exclusions — or determine an individual’s license status — is left to individual discretion.

Better screening tips

The Office of Inspector General for the Department of Health and Human Services over the last two years has used a series of audits to pressure states to better monitor nursing home compliance.

Notably, nursing homes don’t have access to the National Practitioner Data Bank, a national criminal background check system that would let them more easily verify the records of potential caregivers. A Senate bill reintroduced earlier last month would change that.

In addition to advocating for better systems, Harris and Brake said nursing homes should ensure they include these key elements in their current screenings:

- A criminal background check

- Confirmation of credentials with granting schools

- Confirmation that Social Security numbers match credentials or licenses

- Comparison to state and federal exclusion and preclusion lists

- Voluntary fingerprint submissions in states where they’re not required

- Reference checks

“It’s very labor intensive,” Harris added. “But the problem is, if you don’t do it and don’t do it correctly, these things can happen. You can hire someone who is not qualified or you hire someone who has been kicked out of a program.”

Extra steps

A robust and well-documented system can help prove to surveyors, courts and licensing boards that a facility’s team did its due diligence at the time of employment.

In New Mexico, the state Department of Justice said Gonzalez was terminated by several facilities “due to patient safety concerns after displaying a questionable method of delivering medical care and a lack of knowledge during patient care.” But her lack of ability didn’t prevent her from being hired at multiple locations in quick succession.

Gonzalez’s actions repeat elements of other notorious cases, including that of “Killer Nurse” Heather Pressdee, and a Georgia man who used someone else’s credentials to work as a physician seeing more than 500 residents across several senior care facilities in South Carolina.

While fake documents might be hard for any official system to flag, insisting on fulsome referrals from past employers could help. So, too, could a generous onboarding period that includes extra oversight even for licensed employees, Harris said.