At least 88 doctors in Puerto Rico are accused of getting their credentials through bribery or fraud. Federal agents searched across the territory with arrest orders early Thursday.
Television stations broadcast images of some of the arrests by Food and Drug Administration agents and local police - including that of Pablo Valentin, a former executive director of the island's medical licensing board.
Thirty-seven people had been arrested by midday and another 10 were at large, Jose Ruiz, an assistant U.S. attorney in charge of the investigation, said at a news conference. He said the remainder had turned themselves in or agents knew their whereabouts.
Most of the suspects are Puerto Ricans who studied in the Dominican Republic, Mexico or Cuba before taking an exam to practice medicine in the U.S. Caribbean territory, said interim U.S. Attorney Rosa Emilia Rodriguez. The majority had obtained licenses and were working at hospitals on the island.
The arrests are related to an investigation by the Puerto Rico legislature into allegations that the licensing board altered the results of low-scoring tests and awarded licenses to candidates who did not qualify.
Members of the licensing board took bribes of as much as US$6,000 (EUR 4,400) to change the grades of failing exams in some cases, Rodriguez said.
The defendants will face charges including mail fraud and making false statements to Medicare, she said.
A Drug Enforcement Administration spokesman, Waldo Santiago, said his agency is investigating whether those charged had prescribed medications. If so, they could face felony charges including violations to the controlled substance act, he said.
"We cannot allow doctors who obtained their license in an irregular way to practice medicine," said Rosa Perez Perdomo, Puerto Rico's Health Department secretary, in a written statement. "The health of Puerto Ricans has to be protected at all costs."
The licensing board has implemented new safety measures since allegations of irregularities began surfacing more than a year ago, said Milton Carrero, board president.
Cameras were installed in the room where medical licenses are kept and anyone with access has to report to a supervisor and sign in when picking up or dropping off documents, Carrero said.
An investigative committee formed when the allegations first surfaced will now look at licenses issued prior to 2001 to determine if others were obtained through fraud, he said.
Our responsibility is to detect these cases," Carrero said. "There is no doubt that changes at the licensing board are happening and will continue to happen."
Licensing board officials earlier said that the U.S. Attorney's Office was investigating around 120 doctors for alleged fraud.
Florida, Arizona and New York are among the U.S. states that accept medical licenses from Puerto Rico, according to Puerto Rico's medical examining board, though there have been no reports of those accused in the case practicing outside the island.