While there is little apparent information on the incidence of physician impersonation, the issue periodically rears its head in the media, as in February, when news came out that a Florida eighteen-year-old was caught operating an illegal medical office.
That case emerged after the teen had allegedly operated a prior illegal medical practice in October 2015, and before that, posed as a doctor at Florida's St. Mary's Medical Center for a month in January 2015. The teen, Malachi Love-Robinson, was arrested after continuing to practice unlicensed medicine at his second clinic despite receiving cease-and-desist orders. He had not been charged over the St. Mary’s incident because he did not actually treat any hospital patients, though he interacted with them and was said to have “peeked in” on gynecology exams.
While infrequent, it does happen
Certainly, impersonation does not appear to be a common form of healthcare fraud. According to a late January report from the U.S. Government and Accountability Office, impersonation didn’t even make the list for the year studied.
“We didn't find any examples of physician impersonation in the cases we reviewed for 2010,” GAO spokesperson Kathleen King told Healthcare Dive. “To my knowledge, no one else has reviewed fraud cases in other years, so I can't say whether there have been other cases.”
That report notes the most common forms healthcare fraud to be fraudulent billing, billing for services that were not medically necessary, falsification of records to support fraud schemes, kickbacks to participants in fraud schemes, and fraudulently obtaining controlled substances or misbranding prescription drugs.
Anecdotal cases of impersonation, however, do appear periodically in the news. For one example, the Huffington Post hosts a “Fake Doctor” subject page with eleven articles that date back to 2011.
Why does it occur?
The question of how fake medical doctors do it has numerous answers because the fraud can take many forms, a review of news reports shows.
Some fakes reportedly operate independently from home or from offices they rent, or pose as home-visit physicians. While those cases are certainly disturbing, those that are perhaps the most startling are the ones involving fake physicians who manage to practice out of legit clinics and hospitals. Those are the ones that reveal the holes in organizational security and the complacency of employees who assume they belong.
Another major variable is motive; while many fakes appear to be driven by money, others may be after the experience regardless of whether they get on a payroll or bill patients, as when Love-Robinson flitted around at St. Mary's. Other reasons could run the gamut and may not be readily apparent.
There are a variety of ways in which fakes infiltrate institutions. One way is by stealing another physician’s identity—particularly the identity of a physician with the same name, as in two California cases in which men named Keith Barton and Gerald Barnes each masqueraded as same-named physicians.
Another way is through the use of fake medical degrees offered online, which reportedly range from outright forgeries of degrees from recognized institutions, to those from fake or quasi-real universities. Some who use such sites may argue, and perhaps even believe, they earned the right to call themselves MDs or PhDs. Florida teen Love-Robinson claimed he received a PhD from a California-based university that he attended online and also claimed certification from several alternative medical organizations.
According to Degree Mills: The Billion-Dollar Industry That Has Sold Over a Million Fake Diplomas, published by Prometheus Books in 2012, “Fake medical degrees are an urgent problem. It is easy to buy a medical degree from a fake school, or a counterfeit diploma in the name of a real school."
Check yourself before you wreck yourself
Sometimes, none of that may even be necessary if institutions fail to check credentials, perhaps relying on a candidate’s word, reputation, or the idea that they must have had credentials to have achieved whatever position they held previously. One of the most high-profile such cases involves a Michigan man who claimed to be a physician for 15 years, and was caught in 2010 when someone finally checked his credentials while he was serving as medical director for the medical simulation and research program at Beaumont Hospital in Royal Oak. He is said to have secured millions of dollars in research grants, fees, and salaries for performing research and training but did so without performing patient care, which is perhaps how he avoided scrutiny for so long--and perhaps how he avoided being regarded as a physician impersonator in the GAO's report on 2010 healthcare fraud.
While fraudsters operating independently are a matter of buyer-beware for patients, the fact that some continue to make their way into institutions, whether to act in a formal capacity or simply circulate unimpeded, is a stark reminder to healthcare institutions to beware as well.