Identity fraud, illegitimate customer onboarding, and various other scams are the prevailing challenges every industry is facing. Similarly, the medicare sector is also on the verge of experiencing a dramatic increase in these threats. This will lead to losing billions to penalties and falling victim to medical scams. These include false insurance claims, prescription fraud, availing illegitimate benefits, and much more.
The healthcare sector requires robust patient verification solutions to mitigate these risks in the first place. Medicare providers can verify patient identity and ensure the right ones are getting the treatment. Similarly, they can safeguard the patient's digital records. There are numerous applications and use cases for Know Your Patient (KYP) checks, the most prominent of them are covered in this blog.
Patient Identity Verification – Addressing Several Fraud Risks Healthcare Sector Face
Healthcare centers are experiencing an increase in criminal attempts which is forcing the regulatory authorities to enforce more strict requirements. As per the guidelines, hospitals, clinics, pharmacies, and other online medicare providers need to verify patient identity prior to giving any assistance. As per Health Insurance Portability and Accountability Act (HIPAA), medical care centers should ask patients for their information.
They should also manage and safeguard these details to avoid data breaches. However, criminals still manage to commit medical scams and healthcare providers require more than just patient identity verification. As per Shufti Pro News, fraudsters use fake documents and information to illegitimately dodge the patient verification process. The next section covers more similar risks that medical care providers experience:
Rise in Cybercrimes
Where the healthcare sector is bringing improvements in its operations, cybercriminals have intentions otherwise. The rapid shift of pharmacies to e-drug stores is increasing the chances of minors committing prescription fraud. Similarly, fraudsters use fake information to bypass know your patient and attain prescriptions to buy restricted drugs. Medical care providers are streamlining the online treatments and consultancy by providing video or audio call facilities.
However, fraudsters use advanced technologies to impersonate imposters and commit cybercrimes. This calls for effective mechanisms to identify patients and provide security to their telehealth records. For this, medicare providers need to employ a better know your patient mechanism to streamline the online assistance.
Medical Data Breaches and Scams
In the previous years, when digitization is taking over, the healthcare sector faces an increase in medical identity theft. Fraudsters commit data breaches and either upload the details on the dark web or use it for personal gains. HIPAA’s journal stats show that there were over 44 million data breaches in 2021 faced by medicare providers.
Therefore, regulatory bodies are seen in more action as they enforce strict know your patient regulations. Not just hospitals but drug e-stores, online clinics, and other such subsidiaries need to perform efficient patient age verification along with identifying their identity details. The AI-powered IDV services here provide robust mechanisms to verify patients more accurately.
Prescription Fraud and False Insurance Claims Taking Over
Along with data breaches and identity theft, medical care providers are also facing a simultaneous increase in prescription fraud and false insurance claims. Criminals use the fake information to illegitimately dodge patient verification process, onboard platforms, and back their treatments. This way they deprive legit patients of their insurance rights.
Similarly, fraudsters use Personally Identifiable Information (PII) of the legit patients to avail prescriptions. This helps them bypass identifying patient processes and buy restricted drugs online. Minors also use their elders’ information to buy age-restricted drugs that lead to fatal addictions. Therefore, the healthcare center and all of its subsidiaries need to incorporate efficient patient verification solutions.
Security Hacks Reaching Alarming Stage
While technological sifts have a myriad of benefits, they also hold several drawbacks. The online consultancy, medicine purchase, treatment payments, and other advantages are opening loopholes for fraudsters. This compromises the security of patients’ records. Fraudsters use sophisticated ways to bypass identity checks and apply for illegitimate benefits.
While criminals bring in methods to dodge know your patient processes, digital services shield the healthcare sector’s operations. Similarly, e-drug stores can perform ID verification for pharmacies to mitigate chances of prescription fraud.
In the End
Criminals often use fake information to camouflage their identities and apply for illegitimate medical benefits. They do this to either pay for their costly treatments or reap insurance benefits. Therefore, the healthcare sector and all its affiliates should accurately verify patient identity. According to the regulations, healthcare centers should employ Know Your Patient (KYP) checks to keep their legitimate patients’ information secure. Also, they should keep track of changes within the medical records of patients. Here, the AI-powered verification solutions enable healthcare centers to access global databases. This way healthcare providers can ensure that they are facilitating legitimate patients.