The Importance of Proactively Eliminating Healthcare Fraud

Being Proactive vs. Reactive

It’s often said that the true distinction between being proactive versus reactive is the difference between responding and reacting. Response is rooted in choice. Reaction is ruled by habit. Proactive thinking looks to the future and is generally considered the anticipation of an event that is known to happen whereas reactive thinking is exactly that – responding to something that has already taken place. Whether or not you tend to fall into one camp or the other, it’s clear that in business, being proactive can pay a lot more dividends than taking a reactionary approach.

The Problem of Being Reactive to Healthcare Fraud

Just as many other industries put their clients at risk of fraud because of antiquated or ineffective identification protocols, the healthcare industry is currently experiencing a sharp rise in the amount of fraud it sees across its landscape. Although the term “fraud” in healthcare can relate to a number of categories – Medicare & Medicaid fraud, health insurance fraud, and drug diversion – we are focusing on medical identity theft at the point of service as our point of reference and the ability to proactively implement technology to thwart it.

Recent statistics from The Ponemon Institute survey on medical identity theft in the U.S. indicate that not only are the number of medical identity theft victims increasing (the number of new cases in the last year is estimated at 313,000 and it is estimated that 1.84 million adults became victims of medical identity theft) but the focus on the impact of medical identity theft is rising and patients are increasingly becoming aware of it’s risk. Perhaps more poignantly, most medical identity theft victims lose trust and confidence in their healthcare provider after the loss of their medical credentials, and this number is getting larger. Additional important statistical information from the report indicate:

• Patients rarely take steps to check their medical records – 78% of people in the survey understand that it’s important to monitor their medical records for accuracy but fail to do so
• 30% of survey respondents allowed a family member to use their personal identification to receive healthcare services
• In a majority of cases, medical identity theft is preventable at the point of service – 30% of survey respondents say the crime happened because they knowingly shared personal identification information with someone they knew and 28% say someone from their family took their personal identification without their knowledge or consent

What can we glean from this? Setting aside the obvious conclusions that medical identity theft jeopardizes patient safety, puts lives at risk, and costs the industry millions of dollars per year (the Ponemon Institute survey estimates total out of pocket financial losses for patients to be approximately $12.3 billion), we start to understand that many patients are not taking the proper steps to protect their medical identities and a large percentage still do not fully understand the impact that medical identity theft can have on their safety and financial well being. We can also conclude that although patients must be diligent about maintaining control of their identity and conducting periodic checks of their medical records and explanation of benefits (EOBs) for errors and misinformation, clearly the healthcare provider can play a more proactive role in helping to prevent medical identity theft at the point of service through internal patient identification process reviews and instituting modern identification technologies that can stop medical identity theft before it mushrooms into a potentially life threatening problem.

The Healthcare Providers Role in Preventing Medical ID Theft at the Point of Service

One may look at the Ponemon survey and say it’s apparent the burden of preventing medical ID theft falls squarely on the patient’s shoulders. However, astute healthcare providers understand that the battle against medical identity theft is a strategic combination of an outgoing patient education campaign to be continually diligent about monitoring their medical records and EOBs and an internal campaign of adopting modern patient identification software that can readily prevent medical identity theft at the point of service. In other words, the fight against medical identity theft is a bilateral effort between patient and provider, and not exclusively the responsibility of the patient alone.

So what can healthcare providers do to help in the fight? First and foremost, they must accept the reality that even though they may have never been the victims of fraud through identity theft, it can happen to them. More importantly, it only takes one case (one!) of medical identity theft to incur potentially millions in legal fees and settlements, not to mention the potential harm to the patient which can result in damage to reputation and loss of patients who lose faith and trust in the ability of a provider to do their part in helping to protect identities.

Healthcare providers who want to proactively help stop medical identity theft at the point of service can rejoice in the fact that there are new technology weapons available that can help eliminate the problem and help maintain or even bolster the reputation of the provider by patients who understand the value these technologies have to protect them from injury or even death. One of these is the use of biometrics for patient identification. Slowly, biometrics is permeating the healthcare patient identification landscape and for good reason. The use of biometrics for patient identification not only securely identifies patients upon arrival and at each touch point through the continuum of care, but it also ensures that the correct medical record is used for clinical documentation, and the possibility of creating a duplicate medical, overlay, or overlap is quickly eliminated.

Furthermore, patients are clearly becoming much more intuitive about the technologies that exist to help protect them while present in a medical environment and keenly observant on their visits on what their healthcare providers are doing to help protect them from harm. Using a technology like biometrics for patient identification is highly visible, and an important talking point during the patient registration procedure that providers are proactively taking steps to solidify accurate patient identification during registration and all along each touch point of care. This not only invokes patient confidence, but in a digital age where increasingly social platforms are used as communication spring boards to share ideas and information – this is the type of information that can spread quickly and help bolster the reputation and perception of a healthcare facility that they are indeed doing their part to stop medical identity theft at the point of service.

What are some other ways that healthcare providers can proactively fight medical identity theft at the point of service?