What Happened With the USMLE Cheating Scandal?

In February, we reported on a cheating scandal that resulted in U.S. Medical Licensing Examination (USMLE) scores being invalidated for hundreds of Nepali test takers, some of whom later filed a class action lawsuit. In this report, we follow up on what has happened since.

Nearly a year ago, the USMLE program found a pattern of suspicious results, and after an investigation, invalidated the scores for 832 Nepali test takers. Some had scores for just one step invalidated while others had all three, putting their careers and visa status in limbo.

One of the people who had all three scores invalidated — Latika Giri, MBBS, a Nepali medical graduate who lives in Kathmandu, Nepal — quickly launched a class action lawsuit against the National Board of Medical Examiners (NBME), which co-runs the USMLE. Her legal team also filed a preliminary injunction to restore score validity, which was denied by Judge Christopher R. Cooper.

A few weeks later, the plaintiffs amended and refiled their complaint, alleging discrimination based on national origin and demanding $80 million in damages, at which point Swechha Shrestha, MD — who holds Nepali citizenship but lives in Nevada and had her step 3 score invalidated — joined the suit.

The latest legal filings date back to June and July, when NBME filed a motion to dismiss and the plaintiffs subsequently filed an opposition to that motion, as well as other exhibits and replies. Some of those documents reveal new information on the scope of the case. Notably, most people — 618 out of 832 — only had one step’s score invalidated, while 202 had two invalidated. Just 12 people, including Giri, had their scores from all three steps flagged.

Meanwhile, the USMLE had given the people whose scores were invalidated three options on how to proceed: they could either retake the exams at no cost (though if they failed they will be barred from the USMLE for 3 years), they could request that the USMLE reconsider their score invalidation, or they could do nothing and have their score remain listed as “Score Not Available” and also be barred from the exam for 3 years. According to exhibits filed in the court documents, Giri and Shrestha both requested that the USMLE reconsider their invalidated scores, which remain listed as “Score Not Available” until a decision is reached.

A spokesperson for the USMLE told MedPage Today that “a majority of examinees chose to retake their invalidated exams in 2024” and that validation exams have been offered for all three steps with more dates available in 2025 and 2026.

However, the organization said it will not be sharing the score outcomes for these validating exams. The spokesperson also said that “multiple steps have been implemented to mitigate the potential for problematic examinee behaviors, and where direct evidence of misconduct has been obtained specific to an individual, those individuals have been routed to the program’s process for adjudicating allegations of irregular behavior,” though they didn’t give any details about the safeguards.

Bryan Carmody, MD, who runs the popular medical education blog, “The Sheriff of Sodium,” and has been following the scandal closely, told MedPage Today that it makes sense that most people chose to retake the exam and that passing it a second time answers the question of whether they were knowledgeable enough to be a doctor.

Carmody also explained that the Electronic Residency Application Service (ERAS) displays an applicant’s most recent USMLE score most prominently, though the invalidated score on their USMLE transcript could still impact these candidates’ chances of matching into a U.S. residency.

“So if an applicant failed Step 1 and then passed it, all that ERAS shows in the easily accessible part … is USMLE Step 1: pass,” he said, adding that to see their USMLE transcript, which includes an applicant’s complete examination history, another click is required. Carmody suspects that most programs will indeed look at the transcript, but he’s confident that not all programs will. He also thinks the NBME has lessons to learn from this ordeal.

“I think if their announcement had been phrased in a different way, there wouldn’t have been a lawsuit against them,” Carmody said. At the same time, he noted that publicly announcing the findings of an internal cheating investigation was helpful for the organization’s reputation so that people in the field know that they are policing the test.

“Their whole business really stands on their reputation for offering a test that’s fair and reproducible and whose results mean something that’s useful in the world of medical licensure and residency selection,” he said.

Neither the NBME nor the plaintiff’s legal teams responded to MedPage Today‘s request for comment. As of press time, no meetings regarding the case are on the public court calendar and the district court did not reply to MedPage Today’s questions about an anticipated timeline.

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