In today’s fast-paced world, cybercriminals damage the healthcare sector by committing medical fraud through data breaches. The healthcare industry faces severe cybersecurity issues, such as false insurance claims and identity thefts. A report states that in June 2016, 275 people were caught committing medicare fraud, costing around $800 million. The healthcare sector needs to mitigate crimes by incorporating digital identity verification solutions.
The healthcare industry should provide secure patient verification services using biometric solutions to maintain a fraud-free medical environment. Digital identity verification ensures that the patient’s identities are verified before medical services are provided. It prevents identity theft and impersonation risks from affecting the health sector. These digital biometric verification services maintain patient records confidentiality from potential medical fraud.
How do Medical Providers Commit Healthcare Fraud?
Phantom Billing
Medical providers commit phantom billing fraud by submitting service claims to the government that they never performed in reality. They also charge patients for items that were never offered to them.
Double Billing
Double billing refers to submitting multiple financial claims for the same service. Two or more medical providers can ask for payment from the same patient for the same procedure. Patients can be charged multiple times for the same medical service. This is very exploitative for the patients and the healthcare sector as well.
Unbundling
Unbundling is a fraud in which medical providers charge patients through multi-step procedures instead of charging them for just one procedure. By billing each step individually, medical providers charge patients excessive amounts.
Upcoding
Upcoding occurs when the medical provider submits codes to private insurers for more expensive procedures than the patient is diagnosed with. The patients haven’t even received the service for which they are being charged, causing a funding crisis in the healthcare sector.
How Patients Commit Healthcare Fraud
Unlicensed Imitation of Medical Provider
Patients can commit medical fraud by pretending to be healthcare professionals. They can charge for health-related services and equipment without a legitimate license to access them.
Identity Swapping
This is a type of fraud where the patients can allow anyone to use their insurance policy. It can also be done in the opposite way. The patients can use someone else’s health insurance, causing severe identity misrepresentation.
Why Fraudsters Target The Healthcare Industry
Availability of Sensitive Information
The healthcare sector contains a vast range of sensitive identity information. It stores the patient’s details, such as name, address, and passport details. It also contains their medical history and insurance data. This provides scammers great opportunities to access and manipulate this data for their convenience and benefit.
Importance of Healthcare Records on the Black Market
Healthcare data is very valuable in the black market. It contains sensitive information that the scammers can use to breach the patient’s identity and commit identity trafficking. Cybercriminals sell this data for financial gain.
Presence of Multiple Stakeholders
The healthcare industry includes services from various stakeholders, such as insurance companies, clinics, hospitals, and pharmacies. These stakeholders contain plentiful data that the scammers can use to harm the healthcare system and exploit the industry.
Digital Identity Verification Protecting the Healthcare Industry
Due to the large amount of data availability, the healthcare sector is prone to severe cybercriminal challenges. This sector needs a robust digital identity verification solution to overcome these issues and ensure smooth functioning.
Patient Verification During Check-In
The healthcare sector can use face biometric liveness detection to ensure that patients are who they claim to be. They can use automated ICR solutions to ensure that the patient’s records are accurate. Online verification services can streamline healthcare operations because it incorporates AI-powered tools to verify patient’s identities.
Preventing Insurance Fraud
Medical service providers can use online identity verification solutions to determine whether a patient is eligible for insurance services. They can track the patient’s financial records and provide related medical aid.
See Also How Can Forensic Analysis Assist in Identifying Refined Document Forgery?
HIPAA Compliance
HIPAA stands for Health Insurance Portability and Accountability Act. The healthcare sector must comply with this regulation because it ensures the protection of patient’s sensitive data. The biometric verification system helps the healthcare sector to comply with the HIPAA regulations.
Enhanced Patient Experience
When patients undergo several security checks, they realize that their information is protected and secured from any fraudulent activity. This improves their overall experience and trust in healthcare institutions.
Patient’s Record Protection
Using digital identity verification solutions, the patient’s records can be protected from identity theft. It reduces the chances of the information being sold to the black market because the data is protected using advanced verification services and complying with KYC regulations.
Summing It Up
Digital identity verification process in the healthcare sector is crucial to protect patient’s information from unauthorized access. Healthcare institutions can mitigate fraudulent activities and improve their onboarding process using advanced biometric verification tools. They must also comply with HIPAA regulations, which can be achieved with digital verification services. These services also enhance the customer’s overall medical experience.
