Health Law Daily Wrap Up, FRAUD AND ABUSE—6th Cir.: Unlicensed nurse’s patient-care duties justified sentencing enhancement for risk of serious bodily injury, (Nov 13, 2026)

By Ravindra Kumar Singh, B.L.

Administering narcotics, inserting intravenous lines, and removing catheters without nursing qualifications created a sufficiently serious patient-safety risk.

The U.S. Court of Appeals for the Sixth Circuit affirmed a 75-month prison sentence imposed on a woman who used another nurse’s identity to obtain employment at Michigan healthcare facilities. The appeals court held that the district court did not clearly err in applying a two-level sentencing enhancement because her performance of nursing duties without proper education or licensing created a conscious or reckless risk of death or serious bodily injury. Her claimed medical training and practical experience did not establish that she could safely perform those duties (United States v. Gallarzo, No. 26-1119 (6th Cir. Nov. 10, 2026) (not recommended for publication)).

Nursing employment, stolen identity. The woman had previously been convicted in federal and state courts for obtaining nursing employment through falsified credentials. Her federal conviction in 2017 followed similar convictions in Texas and Michigan. Despite those convictions, she subsequently applied for nursing positions in Michigan using another registered nurse’s license number.

After one employer rejected her application because of discrepancies in her information and notified the FBI, the woman secured employment at a skilled nursing home in August 2022. She subsequently transferred to a skilled nursing facility, where she became a unit manager responsible for supervising other nursing personnel. Performance problems eventually resulted in her demotion.

Meanwhile, the Department of Health and Human Services Office of Inspector General initiated exclusion proceedings based on her earlier federal healthcare fraud conviction. The woman was ultimately excluded from participation in federal healthcare programs for five years.

Nevertheless, she obtained another nursing position at a hospice facility in May 2023. That employer terminated her employment after a background check revealed her criminal history and healthcare exclusion.

Investigators subsequently discovered that her responsibilities at the skilled nursing facility included administering medications, including narcotics, starting intravenous lines, removing peripherally inserted central catheter (PICC) lines, checking patients’ vital signs, and supervising nursing assistants.

The woman pleaded guilty to aggravated identity theft and making false statements relating to healthcare matters. While awaiting sentencing, she absconded and obtained additional medical employment in Illinois and California using stolen professional identities before being arrested in September 2025.

The district court imposed a 75-month prison sentence, including a two-level enhancement under U.S.S.G. § 2B1.1(b)(16)(A), which applies when an offense involves a conscious or reckless risk of death or serious bodily injury.

Medical experience. The woman challenged the enhancement, arguing that her previous medical training and extensive practical experience enabled her to perform nursing duties safely despite lacking formal nursing qualifications.

She maintained that she had undertaken medical assistant training and attended courses at Davenport University. She also claimed to have obtained a nursing degree from Belford University, subsequently identified as a fraudulent online institution. Although she acknowledged lacking formal nursing education and licensing, she contended that her practical experience compensated for those deficiencies.

The district court rejected her position, finding that the risks associated with performing nursing procedures without appropriate qualifications were obvious. The woman appealed, arguing that the government failed to show her conduct actually endangered patients.

Patient-safety risk. The Sixth Circuit rejected Gallarzo's argument. Citing United States v. Wala, 166 F.4th 583 (6th Cir. 2026), the appeals court explained that the enhancement does not require proof of actual injury, provided the reckless risk was real rather than conjectural.

The court found that administering narcotics, starting intravenous lines, and removing PICC lines could cause death or serious bodily injury if performed improperly. Nursing education and licensing requirements exist precisely to ensure that individuals undertaking such potentially dangerous responsibilities possess the necessary competence.

The woman's performance-related demotion further supported the district court's assessment. Although she argued that the record did not establish whether her performance problems involved nursing skills rather than attendance or other workplace issues, the appeals court found it plausible to infer deficiencies in her nursing abilities.

Applying the clear-error standard, the appeals court explained that the district court's findings warranted affirmance if plausible in light of the entire record. It was unnecessary to establish that the woman had actually injured a patient or that every aspect of her nursing performance was deficient.

The district court therefore did not clearly err in finding that the woman's conduct created the requisite risk of serious harm. The Sixth Circuit affirmed the judgment and sentence.

The case is No. 26-1119.

Judge: Clay, E.

Attorneys: John Jordan Schoettle, Office of the U.S. Attorney, for the U.S. Rachel L. Frank (Rachel Frank Law) for Leticia Gallarzo a/k/a Leticia Gallarzo-Monarrez.

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