Fake Doctor Twice?! Arrested. Released. Arrested Again.

[00:00:06] Well, Nyleen and Shannon sitting there talking about you while you pull up a chair. If you come across someone practicing without a license or a credential that doesn't check out the way it should, you literally have an obligation to say something. In California, that starts with the Department of Consumer Affairs Health Quality Investigations Unit, which is who actually investigated this case alongside local law enforcement.

[00:00:33] Every state has an equivalent licensing board investigations unit and most have online complaint portals. At the federal level for Medicare and Medicaid related frauds, specifically the HHS Office of Inspector General hotline. That's 1-800-447-8477.

[00:00:54] Or you can even file a online OIG.HHS.gov if you actually are thinking that somebody has committed some type of federal fraud. Oh, and we're going to put this in the show notes of this episode. So, welcome back to Credentialing Chronicles. Nyleen, here we are. Part of our hype series. I'm Shannon. And I'm Nyleen.

[00:01:19] Shannon, I want you to explain the title of this episode to people because it sounds a little bit like a typo. I know. When you was telling me about it, it's not a typo. This is a man who was literally arrested for practicing medicine without a license, you guys. Released on bail with an explicit court order not to practice medicine. And guess what? He was arrested again. Why? For practicing medicine. While out on bail. For practicing medicine.

[00:01:49] Nyleen, what are we doing? Oh, my goodness. Say it a third time. It does not get less unbelievable. It doesn't. It doesn't. I mean, this is the case of, you know, I mean, a lot of people called him Nate. He was out of Ventura County, California. And it is one of the clearest real world illustrations we've ever covered of exactly why license verification cannot be a one-time event.

[00:02:16] This is a perfect opportunity to plug in our sponsor, Bataan. How many state board tabs do you have open right now, Nyleen? Oh, Shannon, way too many. And that's exactly why our sponsor, Bataan Health, exists. Search, verify, monitor, and keep the receipts, honey, for the auditors. BataanHealth.com. All right, Shannon, thanks to our sponsor.

[00:02:43] But first, we have to do a little bit of a disclosure because we have not personally credentialed this doctor or have discussed with anyone his personal peer review information. All charges described are allegations from public court filings and law enforcement press releases unless a plea or a conviction is noted. This is for informational purposes only and is not considered legal or credentialing advice. So this is one of those episodes where we got to say allegedly. That's what you're saying, right?

[00:03:14] Allegedly, yes. So I guess it all starts in Ventura, California at a clinic called Regan Spine and Nerve. Always the spine doctors. You know, that was the doctor death out of Texas. He was a spine doctor too. It's a website advertised as natural, non-surgical, non-drug alternatives to combat pain or even dysfunction. And working there, treating the patients, Ms. Nyleen, was a man that was calling himself a doctor.

[00:03:41] He was claiming to be a graduate of Avalon University School of Medicine, a school located in... I can't even say the word. Can you say it for me, Nyleen? Curacao. With specialties that he described were in neurology, neuropathy, chiropractic medicine, and even a little bit of gut health. Shannon, that doesn't even make sense. How are you going to be a chiropractor, a neurologist, and a gastroenterologist?

[00:04:11] I'm a little confused. Nyleen, Nate said he did it all. Nate said all the systems was connected and Nate does it all. I don't see how any of that could be true, honestly. Well, I mean, you're confused, Nyleen. What do you think the California Department of Consumer Affairs was thinking? I mean, the guy doesn't even hold a medical license, Nyleen, in California. In literally no capacity. Not as a doctor. Not as a surgeon.

[00:04:41] Girl, he ain't a nurse. He's not a nurse practitioner. He's not a chiropractor. He doesn't like green eggs and ham. Oh my goodness, I can't. And he is not a licensed physician in any of the state of the United of these states. Oh my goodness. I know, I know. And in February 2025, the Ventura County District Attorney, honey, they done got involved. They done got involved, charged him. A felony. These are felonies that he's getting, you know.

[00:05:10] One felony, one misdemeaned account for practicing medicine without a license and literally representing himself as a doctor. So if you're out there doing that, y'all, there's criminal charges associated with it. So that, of course, is arrest number one. Because, I mean, you can't pretend you're somebody that you're not, obviously. I mean, we as credentialing professionals know it all too well, right? So, yeah, I guess you want me to just break down the whole credentialing, the whole arrest history.

[00:05:40] Well, you know, we love all the crime women. We're MSPs, so we want the details, Shannon. We need the details. Yeah, you're right. You're right. Give me the receipt. So he was arraigned on a felony complaint that had grown from being unlicensed practice of medicine, okay? Fraudulent use of the term doctor and physician and literally identity theft, like you said, of a vulnerable person.

[00:06:05] Okay, so the prosecutors alleged that he had used the personal information of an elderly or dependent adult to attain a line of credit without the person's consent, girl. He pleaded not guilty to all these counts, and then they literally released him on a $10,000 bail. Wow. Well, I'm assuming that the bail conditions were specific, right? Honey, the judge was extremely specific.

[00:06:33] Judge David, I don't know how to say his last name. His order was explicit, Nailene. Nate was not to provide any medical services to any patient. Not to offer any services. Not to seek any patients. Or he would be taken back into custody immediately. Okay, so that sounds pretty serious, right? So how long did that last? I think maybe two or three days, Nailene. I think maybe two or three days. Yes.

[00:07:04] Nailene, I mean, how do we make it up for the people out in the credentialing world? But literally, according to the DA's office, only days after this man was arraigned, Nate was back out there at the Spine and Nerve Institute treating the patients allegedly and accepting the payments. The exact thing allegedly that the judge had told him not to do. And that part is not allegedly. The judge did say don't do it. Oh my goodness. So they arrested him again, I'm assuming, right? Yes, yes.

[00:07:33] On May 5th, 2025, he was arraigned second time. New charges, practicing medicine without a license. Plus a new charge, Nailene, specifically for using the title doctor and the DR prefix to imply that he was literally a licensed medical professional. And prosecutors kept the identity theft and the elder theft charges from the first case moving in parallel.

[00:08:00] So what was raised, you know, I think bail was raised at like $50,000 now. And this time the judge's order was, if possibly even more direct, if he practices medicine. If he tries to, because he's not practicing medicine because he's not a real doctor. So let's say if he pretends to practice medicine, right? Be explicit, right? And that's what he should have said, Nailene.

[00:08:26] If he solicits for the business of anything in medicine, if he attempts to treat the patients or receives compensation for any medical work, he is remanded into custody. There's no ambiguity left in that, Nailene. Before we move on, let's take a second to thank our sponsor, HST Pathways.

[00:08:46] This episode is sponsored by HST Pathways, the cloud-based platform helping ambulatory surgery centers bring scheduling, clinical, financial, and patient workflows all together. Schedule a demo today at hstpathways.com and let them know that Credentialing Chronicles sent you. Okay, Shannon, back to the show. Talk to me about who he was actually targeting because the charging language keeps saying vulnerable.

[00:09:15] Yeah, yeah, it does. You're right. And prosecutors really made that explicit. The felony complaint cited aggravating circumstances, including that the manner of the criminal indicted, planning, sophistication, and professionalism, that it involved an attempted and actual taking. And that, Nate, took advantage of a position of trust. Of course. Right? I mean, I agree.

[00:09:43] I mean, between the two arrests, Nailene, he was also charged with identity theft and theft from an elderly or dependent adult, like we said. Right. So this wasn't opportunistic. This was a repeatable business model built around people who wouldn't ask too many questions. Right.

[00:10:04] And I'm assuming he was trying to do this self-pay medicine, which really hurts my heart because there are a lot of good things happening in regenerative and holistic medicine with real doctors. And it's a shame that this person would put such a damper on the role and safety and the love that we place over our true good doctors. And you ain't lying.

[00:10:34] And you is not lying. Right? And, you know, people, even the doctors now that are trying to do the self-pay, you know, it just puts a damper off that. Yeah, yeah. No, I know what you're saying. Right. Um, so, I mean, you know, like he said, he was literally targeting these people. Um, that's exactly, you know, how they read it as well. And I want to flag something for our credentialing audience specifically. This wasn't his first appearance in a healthcare setting, you guys, under a title that he wasn't entitled to.

[00:11:02] I mean, this is someone who built an entire clinic brand, Regan Spine and Nerve, complete with a website, Nyleen. He literally described specialty lists and acclaimed medical school credential, all of which would have been trivially disapproved with a single primary source verification call. Wow. Yeah.

[00:11:25] Because if you would have just made one phone call to the university registrar, or honestly just went on a board, if he's not board certified, or just went to the board of California, which by the way, is one of the easier sites to navigate. So I'm like, you go to the California medical board and you try to look up a license. I mean, that's the simplest thing that it's a good state. You could do.

[00:11:45] And that's what we tell our patients to do all the time is when you see a doctor, when you're going to get ready to see a doctor, the first thing you can do is at the minimum, check his license and see if there's any actions on the license. Right? Yeah. I mean, especially with all the med stuff, spa clinics popping up, like you said, all the holistic clinics popping up. Like I understand that you can give a good back rub and make somebody feel real good, but honey, that does not mean you are a doctor. It does not make you a DC chiropractor.

[00:12:11] They're a practor like they are going through years of school, residency, training, mentorship. You know, I mean, it's a process, baby. Okay. You don't just walk into a welding shop and say, I know how to weld. Right? So, I mean, I guess that's it. That is the part that should really sit with anyone in provider enrollment. I mean, to be honest, this clinic wasn't operating in a shadow economy. It had a public facing website.

[00:12:38] It was findable and it was marketing itself using specific clinical claims. The gap wasn't secrecy. You know, the gap was that nobody with verification authority ever looked it up. Right. So, let's just say that as of this recording, both of the doctor's cases are moving through the Ventura County Superior Court. And the DA's office has publicly asked anyone who received treatment or care from this doctor

[00:13:04] to contact their investigator directly and has reminded the public they can check any health care provider's license status through the California Department of Consumer Affairs website. So, if you're a person, if you're new to credentialing, if you're a physician, go to your licensure medical board. A lot of times it is called the Consumer Affairs. A lot of times it's called healthcare licensing. Like, there's all different kinds of terminologies that they use.

[00:13:31] But if you just Google, I want to check my doctor's license in this state, it will show you the website. Yeah. Verify. And you could do it. So, let's say they don't put you with the doctor. They put you with the nurse practitioner. Verify a nurse practitioner in Texas. It's going to bring you the website. Verify a chiropractor in Alaska. It's going to bring you to that website. And at the minimum, people that are seeing you all should have a license. You know, I mean, Nyleen, it's the first lesson, most uncomfortable one.

[00:14:00] This man was arrested, released an explicit no practice order and violated it within days. There are people out there that are doing this and this is their game. And so, y'all have to protect yourselves for yourself, for your family. You know, and he was practicing at the same clinic under the same name. I mean, in his head, he was okay to do it. And the court order was not, you know, orders are not enforceable mechanisms in real time, right?

[00:14:25] So, nobody is standing in the waiting room saying, oop, if you see a patient, we're going to get you. I mean, so again, that's why you have to protect yourself, like Nyleen is saying, by verifying yourself. The burden of verification is on you sometimes as the patient. Right. Right. And so, let's just talk about billing a little bit because secondly, right, it's a textbook argument for why license verification has to be continuous and payers or anybody that's billing for this. And I'm sure this is probably self-pay. So, insurances weren't involved.

[00:14:55] But this is why having a payer moment process where they are also verifying licenses and statuses, they're going to be able to be like the second double check, right? A felony charge in an active no practice order would have surfaced immediately. Primary source verification isn't just like a firing day formality, right? You've got the sanctions, the charges and the license actions happening on their own timeline and of course not ours. So, we have to check.

[00:15:24] So, third, Shannon, and this is one that keeps me up, foreign medical school claims deserve a specific verification protocol. Can you talk a little bit about foreign medical school? Yeah. I mean, and you know, to be honest, it's getting a little harder now, right, Nyleen? Because they're passing. Yes. I mean, we've talked about this in a lot of our live shows because, you know, people are able to come over and say, oh, I was a doctor over here. And so, they're not even requiring residency anymore. They're not requiring, you know, those extra additional years over here.

[00:15:54] And so, you know, they're under a special license with the medical board. But again, that is the valid way now. It's a special license that is verifiable under that medical board. So, yep. And so, the last piece is this case is a strong argument for public license lookup, like we have said. The Ventura County DA office is explicitly telling the public to please check the status

[00:16:18] of whomever they are seeing to make sure that they are their own last line of defense. So, if in your organization, you have concerns about a credential that really doesn't add up, or you are a new hire at an office and you are the office manager because, what is this office manager doing that did not ask for this doctor's license? Like, hey doc, which, how do you even order medicine?

[00:16:45] Because I, in order for me to sign up for a pharmacy to order any cocktail, even like, you know, lidocaine or the steroid, right? If I want to order that, the first thing I had to give to the pharmacy is the doctor's license in DEA. And I don't understand how he got medicine without having a license or a DEA. So, very, very interesting. It's very, yeah. It's very interesting.

[00:17:15] You know, I mean, and it's, you know, every single piece of the fraudulent credential, the medical school claim, the specialty list, the license itself was checkable with a single verification call as far as public records show. And, you know, a lot of times coming in with the foreign medical people just kind of give up. They just say, oh, I couldn't do it. I tried three times. I couldn't do it. Well, I think this is really a case that, you know, is showing us we need to find a way like there needs, you know, to, to be a way.

[00:17:44] Every state has a different story, but one thing doesn't change. Healthcare organizations across the country are facing increasing pressure to navigate a more complex reimbursement landscape, whether it's evolving payer policies, managed care challenges, staffing shortages, or just the need to improve your overall financial performance. Today's surgical providers are being asked to do more than ever before.

[00:18:09] In order for you to get some practical assistance, please visit nimblercm.com and let them know Credentialing Chronicles. Okay, Shannon, thank you so much for the tea today. Where, what are we going to do? What are we going to do next? I'm so excited. I know we have so much stuff coming up. I mean, you know, let's just give a really quick PSA patients. I mean, this was really a PSA for patients. This whole episode was a PSA.

[00:18:35] Patients, verify your license, verify your doctor's license before you go to the doctor. MSPs, verify licenses on initial, recred, and monthly. And doctors, make sure you keep your license up to date. And if you see somebody practicing without a license, tell on them. Okay. But yes. But what is Credentialing Chronicles have coming up? Just so much. So many people have just been contacting us and we're really excited about that and the opportunities that are presenting itself. But, you know, we're going into NAMS.

[00:19:04] NAMS is coming up in October. And honey, we are bringing the tea. We are bringing all of our teeness of this year to the finale of NAMS. Right? Right, Nailia? Yes. Yes. And so we are so excited to see all of you there. And in the meantime, please listen, subscribe, follow, look at our crazy reels. And we're trying to do the best that we can to keep this relevant, informed, a little gossipy. And hopefully all of you learn something. If you have any suggestions, please email us at Credentialing at Credentialing Chronicles.com. It takes a team.

[00:19:34] It really does. And we absolutely love the opportunity to share your tea anonymously. So follow on YouTube, subscribe on Apple, Spotify. We would love to keep it going. So we're going to spill the tea one credential at a time. So Shannon, we're going to say Credential, not. Not cancel, baby. Till next time.