Nursing Home Aides’ Papers Found Bogus

Nursing homes throughout Los Angeles have unwittingly hired dozens of unqualified nurse assistants who got state certification by paying a fraud ring that infiltrated the state’s testing system to doctor their test scores.

So far, state Justice Department officials have arrested 76 people involved in the scheme, and state health officials have revoked 124 certificates for nursing assistants.

“It’s a new crime of opportunity,” said Deputy Atty. Gen. Mark Zahner. “There are people out there so motivated by greed that they take advantage of the job situation and the elderly and infirm. They don’t care that they’re putting lives at risk by sticking people in nursing homes under false pretenses and putting them into a position to really hurt somebody.”

More cases are likely to surface soon. Both the California Department of Health Services and the Justice Department confirmed that other probes are currently underway, but declined to comment on specifics, citing their policy not to discuss details of ongoing investigations.

A lack of certified nurse assistants has created an environment that invites fraud in the nursing home industry, magnified by the pressure on administrators to fully staff their facilities while holding down wages.

“There’s definitely a shortage of CNAs,” said Mitchell Miller, who manages the DHS complaint department. “And that makes it easier for unscrupulous people to slip into the system.”

Medical industry observers note that as baby boomers are aging, nursing homes face a growing patient population and a dearth of qualified staff, especially CNAs. It is a problem that promises to worsen in coming years.

Nurse assistants perform 70% of all hands-on patient care, from emptying bedpans to recording blood pressure, according to a study by California Office of Health Planning and Development. They also earn the least of all nursing staff, averaging $9.17 per hour in 2000. Licensed vocational nurses earned $17.23 per hour and registered nurses averaged $22.74 per hour that same year.

The result is a fluid job market in which 60% of CNAs switch employers within one year, frequently moving from one facility to another for slightly better pay or hours, according to the state’s study.

In the last three months, Justice Department prosecutors have charged 76 people with paying for a nurse assistant certificate and then using the credential to find work at nursing homes. Law enforcement officials expect “another 20 or so” arrests before the investigation is closed. The Health Services department has revoked 124 CNA certificates in its ongoing investigation.

Two of the key figures in the case, Juan Carlos Cano, 25, and Carole Ann Lopez, 40, pleaded no contest last month to felony charges that they orchestrated the scheme to certify unqualified CNA applicants in the Los Angeles area by altering the results of state eligibility exams. Both have been stripped of their licenses and sentenced to 300 days in jail and five years’ probation, and together they owe nearly $100,000 in fines and restitution.

Investigators learned that Cano, a licensed vocational nurse, recruited non-English-speaking Latinos to take the state-mandated, English-only test. For a fee of as much as $500, “applicants” took the exam at South Orange County Community College, where Lopez, a registered nurse, taught classes and proctored the CNA test for a private company contracted by the state. Lopez doctored the scores before sending them on to DHS, which unwittingly issued certificates based on the bogus results. Over the course of a year, the “proctor and doctor” scheme netted the pair more than $32,000.

“These were two of the first people to get jail time,” said Zahner, who supervised the investigation. “I’m afraid they won’t be the last.”

Although the state has a 24-hour phone service to validate CNA certificates, it was not until a nursing home administrator called authorities at DHS, questioning how an employee who didn’t read or speak English could pass the test, that the plot began to unravel.

“It was an effective scam for a while,” said Collin Wong, spokesman for the attorney general’s office. “Whenever someone got suspicious and called in on DHS’s automated phone system to check a person’s certification, it always came up valid.”

To become a CNA, candidates must complete 50 hours in the classroom and 100 hours of supervised clinical instruction, then pass a multiple-choice oral or written exam and a skills test.

False representation as a certified nurse assistant is punishable by up to 180 days in jail and a $1,000 fine.

Miller said officials are always considering ways to make the CNA test more secure, but trusting proctors will not change.

“If you have someone who’s bent on going against the grain, there’s not much you can do,” Miller said. “But we’re strengthening our relationship with the attorney general’s people, and we’re getting better at catching this sort of thing all the time.”

Industry watchdogs say nursing homes and the state agencies that oversee them are also part of the problem. They charge that CNA pay and certification standards should be raised, but that the industry has pushed for lower standards for certification. By keeping standards low, they say, administrators can keep wages down, which in turn destabilizes the job market and opens the door to fraud.

“CNAs only need 150 hours of classroom and clinical time,” said Prescott Cole of California Advocates for Nursing Home Reform. “To become a hairdresser in this state it takes 1,600 hours. The pay is a joke. So little is required of people to become CNAs and do CNA work, it indicates just how poor the conditions are that something like [test fraud] would happen.”

State officials disagree, noting that they periodically review the tests and raise standards as nurse assistants take on more tasks in the workplace.

“We looked at the tests just a few weeks ago,” said Mike Strank, the state’s chief of aide and technician certification. “I felt like they are meeting all our requirements to assess how a person will do in a patient-care setting.”