We found two dozen massage schools tied to prostitution or fraud. Here's what to know.

Two dozen massage schools with connections to prostitution or fraud, or sometimes both. And regulators who know about the problem, but lack the authority to act.

Those were the findings from a USA TODAY investigation last week focused on the role massage schools play in funneling licensed workers to illicit sex spas.

These institutions often operate in plain sight, in office parks or commercial strips, but regulators say they’re difficult to identify. And prosecuting sex trafficking is challenging because it can rely on the willingness of immigrant women to admit they were forced to engage in sex acts.

So it’s often a seemingly insignificant detail, like exam answers hidden in a boot or a forged signature on official school documents, that prompts action. Local massage boards monitoring their licensure data are often the ones who uncover suspicious schools, USA TODAY found.

Read the full investigation: Massage schools across the US are suspected of ties to prostitution and selling fake diplomas. Many remain open.

“We have seen substantial evidence that indicates that human traffickers try to use fraudulent schools to support their operations,” said Ahmos Netanel, the CEO of the California Massage Therapy Council, “specifically in the form of either purchasing diplomas or enrolling their victims in schools that do not provide the education they claim they actually provide.”

Here’s a look at some of the investigation’s key findings.

Why it’s so hard: Even after crackdown, massage schools can live on

State officials have limited power to act when they do uncover schools they suspect of enabling the illicit massage industry.

That was the case at the American Academy of Acupuncture and Oriental Medicine in Roseville, Minnesota. After receiving a tip from a town in 2019, the Minnesota Office of Higher Education investigated the school and found “a theme of prostitution and/or human trafficking.”

The agency didn’t have the authority to investigate either allegation. Instead, the state said the school failed, among other things, to keep up its student records, and ordered it to shut down or find a new owner. The school chose the latter option, although the person who owned the school at the time denies the state’s allegations.

The school was renamed the American Academy of Health and Wellness, but it bears similarities to its past iteration. For example, the past president and owner is still on the payroll to help with the transition.

The Seldin/Haring-Smith Foundation, a family foundation with a focus on college accountability, included the school in a report documenting the connections between sex trafficking and state-approved colleges.

How it works: ‘Diploma mills’ suspected of feeding illicit spas

USA TODAY also documented how far the operators of some massage schools will go to game the system.

In November 2015, a woman was caught hiding the answers to a massage exam in her boot. Members of the Federation of State Massage Boards, the administrators of the licensure test, tracked down the training program she listed. The federation found the owner of that program had taken the test a few months before, but there was something odd about the third button on his shirt. It was larger than the other buttons, and they believed it contained a camera to record the test, according to a court case brought by the federation against the operators of the school.

Further digging revealed the school had worked with hundreds of clients and was offering a suite of allegedly fake credentials to secure a massage license, including certification for training hours that cost $2,800 to $3,800. A fake high school diploma ran only $80. The federation secured a $450,000 settlement in that case, although the details are sealed.

What’s next: Education Department has two weeks

Close observers of the industry say they fear online massage schools could be a new frontier for unscrupulous operators. Owners of these schools say they’re meeting demand.

“We don’t allow it in Nevada,” said Sandra Anderson, executive director of Nevada’s State Board of Massage Therapy. “It’s a trafficker’s dream, online education. Absolutely. That is something they want.”

Meanwhile, a subcommittee of the House Oversight Committee has asked the Education Department to share its procedures to “identify and stop human or sex trafficking connected with postsecondary education.” The subcommittee cited the Seldin/Haring-Smith Foundation’s report in its letter, and its chair, Rep. Raja Krishnamoorthi, D-Ill., said he was concerned some schools might have covered up illegal acts to receive federal money.

“The Subcommittee would like to work together to determine if any other federal funds are unknowingly being provided to bad actors,” Krishnamoorthi wrote to the department.

Support this work with a subscription: Fake diplomas. Prostitution arrests. Forged documents. Massage schools accused of feeding illegal business in the US

This article originally appeared on USA TODAY: Fraud, prostitution linked to massage schools across US: What to know