Investigating Illegal Practitioners: Strategies, Challenges, and Insights

Understanding the Issue

Illegal practitioners are individuals who offer professional services without the necessary licenses or credentials, posing significant risks to public safety. These unlicensed professionals operate across various fields, including a multitude of healthcare professions, law, engineering, social work, and the list goes on. They will employ a variety of deceptive tactics to avoid detection. Most will use occupational titles such as “doctor,” “lawyer,” or “psychologist,” which are interpreted by the public as a sign of special expertise or qualification.

The consequences of illegal practice can be severe, ranging from inadequate healthcare, physical harm, financial exploitation, and substandard construction that poses public risk. Illegal practitioners not only endanger public safety but also undermine trust in the professions they impersonate. They often prey on the most vulnerable segments of society, including new immigrants, economically disadvantaged groups, and those who may not have the knowledge or resources to verify the credentials of their providers.

The Investigation Challenges

These cases can pose many challenges and investigators need to think carefully about the approach they take, not only to get the evidence, but to avoid making the challenge greater by alerting the subject they are being watched.

Illegal practitioners often exploit community ties or create complicit networks that make it difficult to detect their activities. For example, some illegal practitioners operate exclusively within their ethnic communities or rely on personal referrals, which reduces their exposure to the authorities. In one case, an unlicensed dentist was able to operate for an extended period by only accepting clients through community referrals, thereby avoiding detection. These scenarios can lead to non-cooperation as witnesses, employers, or community members may be unwilling to cooperate, due to fear of repercussions or legal implications, or even because they want to protect the practitioner because, like it or not, it is all they (individual or community) have available.

Finding where an illegal practitioner is operating can be difficult, especially when they are mobile or working across multiple jurisdictions.  In another instance, a woman with revoked nursing registration forged documents to gain registration / licensure in multiple jurisdictions, demonstrating the lengths to which some of these fraudsters will go, to bypass regulations. So now we are investigating a person who is practicing illegally but appears to be legal and hops for province to province and even other countries to keep going, trying to stay one step ahead of the investigator, who might not have the authority to investigate in all jurisdictions. This means regulators must work cooperatively and sharing information as well as involve other agencies including immigration and the police.

Some illegal practitioners are hiding in plain sight, by making use of fabricated references, fake backgrounds, or identity theft. I once investigated an illegal practitioner who assumed the identity of her dead sister and openly practiced as a nurse in a hospital with no nursing educational whatsoever. It was by pure luck, that a distant friend of the deceased sister discovered the issue, but not until that illegal practitioner provided “care” to hundreds of people over two years, shockingly without being detected.

Investigative Tactics and Strategies

The investigation of illegal practitioners requires a creative and multifaceted approach. The goal is to obtain evidence that shows the individual is engaged in one or all the following behaviours:

• Holding themselves out as qualified to practice.
• Using a protected title or designation.
• Performing acts restricted to licensed professionals.

Evidence can be gathered from documentation such as advertising, client files, or human resources records. Interviews with coworkers, employers, and clients, as well as surveillance and undercover operations, are also a key component to the evidence gathering process.

Additional strategies involve:

• Following suspects and observing their activities.
• Engaging suspects by requesting their services.
• Infiltrating agencies where the suspect may be working.
• Other tactics we won’t share in this article, to keep what little tactical advantage we can.

The extent of undercover operations can be significant. In one case several years ago one of our investigators (the author) posed as a tourist to catch a healthcare provider practicing in a small tourist community in northern Ontario. This involved staging an accident so locals would bring the investigator to the practitioner for treatment. This allowed the investigator to obtain firsthand evidence, which was captured on hidden audio and video recorders. Had the investigator just showed up looking for treatment, it would have been highly suspicious.

To address the investigative challenges, investigators may need to exercise the powers available to them, such as obtaining search warrants (not always easy to do) or leveraging the influence of other agencies (e.g., insurance companies, or public health organizations). Appealing to employers’ sense of morality or reassuring them about their legal standing can also help gain cooperation. To determine where an illegal practitioner might be working, investigators might use pretext calls, surveillance, social media searches, determining the geo-tagging of photographs can also help identify the location of suspects. It is a range of approaches that must be employed to complete these investigations successfully. This article is not meant to explore these strategies at length, as some level of discretion is important, so our tactics are not widely known.

Legal Considerations and Prevention

The options available to combat illegal practice include cease and desist orders, criminal or quasi-criminal prosecution, and injunctions (civil court orders). Cooperation agreements, like memorandums of understanding (MOUs), can facilitate information sharing and resource allocation across jurisdictions and between agencies, but this is also surprisingly challenging in many cases.

Prevention strategies focus on making it harder for illegal practitioners to operate. This includes moving away from physical licensure cards (forcing online verification instead), educating prospective employers, and publicizing the identities of known offenders through press releases following successful prosecutions or civil injunctions. Many regulators are assertive in this regard and creating greater public awareness. However, despite these efforts the problem runs deep and rooting out these bad actors will take an extreme level of effort, which arguably most regulators are not resourced enough to undertake. So, prevention efforts and reactive investigations when illegal practitioners are identified through complaints, remains the primary approach to managing this problem.

Another consideration is the fact that despite prosecution or court orders, these illegal practitioners must be monitored to ensure they don’t start practicing again.

The Need for Vigilance and Cooperation

Investigating illegal practitioners requires persistence, creativity, and strategic collaboration between regulatory bodies, communities, and law enforcement. Successful investigations depend on a combination of innovative tactics and the ability to adapt to evolving challenges. Public awareness and engagement are also critical in safeguarding against these fraudulent activities, making it essential for everyone to stay informed and vigilant.

Case Study

• A person (later identified as having some experience as a veterinary assistant) is reported to be advertising a mobile service where they can come to people’s homes and spay or neuter people’s cats and dogs
• This person advertises within a narrow community in in their native language
• When this is reported and the advertisement is examined, searches of public registers in several provinces is undertaken, and the person in question is not registered as a veterinarian
• A translator is engaged and given a script to engage the person by phone (call recorded). The script conveys that she operates a daycare in her home and can’t have him to her home to spay her cat… she asks if she can bring the cat to him.
• The illegal practitioner agrees and offers the service and advises of his home address, the cost of the service, and a date an time to attend
• The investigator arrives at the home of the illegal practitioner and says his mother will arrive with the cat in 5 minutes
• A prearranged call is made to the investigator that he answers in the presence of the subject. The investigator reports to the illegal practitioner that his mother was in a minor car accident and won’t be able to attend
• The investigator asks if they can reschedule and offers to pay half the 200 dollar fee now and the rest when they return another day
• All of this is captured on an audio recording
• While at the home the investigator gathers photographic evidence of the coffee table which is set up as an operating table with scalpels, retractors etc.
• All this information is used to apply for a search warrant, which is granted.
• On the date scheduled to return with the cat*, the investigator brings the police to keep the peace and safety, and executes the warrant, gathering all the evidence needed to prosecute the illegal practitioner
• There was no sterilization equipment on site and some instruments had stains on them.
• The illegal practitioner was charged under the Veterinary Act and was also brought to civil court, where an injunction (court order) was obtained ordering him to cease and desist.

*No cats or any animals were involved or harmed in the investigation