Tech Solutions to Address the Alarming Rise of Healthcare Fraud

The FBI estimated costs associated with U.S. healthcare fraud was at $80 billion in 2013. A 2016 healthcare fraud sweep by the FBI involved $900 million in false billing and more than 301 individuals, including 61 medical professionals and 28 doctors. There a number of surprising and frightening ways that people internally and externally can game the system and that can lead to dire outcomes, including the lethal mistreatment of patients that are not properly identified and the ruin of personal finances.

“About 20 percent of victims have told us that they got the wrong diagnosis or treatment, or that their care was delayed because there was confusion about what was true in their records due to the identity theft,” says Ann Patterson, a senior vice president of the Medical Identity Fraud Alliance (MIFA), a group of several dozen healthcare organizations and businesses working to reduce the crime and its negative effects.

The good news is that there are solutions that are easy and effective to implement that will protect both healthcare institutions and patients safeguard. While adoption of new technology in healthcare is painfully slow, especially when it comes to operational efficiency, it is time that practices take notice of how simple and cost-friendly can make a big impact on operations. Case in point, the recent WannaCry Ransomware attack did not intentionally target hospitals but still caused a lot of damage to the NHS.

Common Fraud Schemes

There are several scenarios that are typical for fraud schemes. Below is a list of ways that people are gaming the system:

Rolling Lab Schemes. This healthcare fraud is the result of unnecessary tests that are charged to insurance companies. Insured individuals often get caught off guard because these tests are administered in friendly or familiar areas, such as retirement homes and local gyms.

Medicare/Medicaid Insurance Fraud. Medical service providers that sign off on unnecessary equipment or services (i.e. unnecessary testing) are often involved in this healthcare fraud scheme. They often work with equipment manufacturers who get access to seniors’ and other insured patients’ Medicare or Medicaid ID numbers.

Services Not Rendered. This type of fraud occurs when medical service providers or customers submit false or altered bills to the insurance companies for services that never happened.

Medical Equipment Fraud. In this scheme, insurers are charged for unnecessary medical equipment or undelivered medical equipment. These fraud cases often begin as a deceptive pitch or are presented to insured individuals as “free.”

Medical Identity Theft. This healthcare fraud involves perpetrators who retrieve insured individuals’ insurance identification and other information. They get this data several ways, including via collection of patient information during free screening at health fairs, recruiting corrupt medical staff with access to insured patients’ information, and buying patient information.

Prevention Methods

Prevent insurance fraud by safeguarding your patients’ benefit information and insurance cards, and your provider ID. You can also use a few quick and easy tech solutions to prevent gaming of the system:

Biometric Security Measures. This method includes implementing a biometric verification point, such as facial recognition, and strengthens the identification process. It can be used to match a person to their ID on file, or to confirm a real person that matches the ID on file is trying access information. Biometric Security is especially user-friendly for telehealth and mobile health apps by reducing the need to manually enter ID information or answer time-consuming, knowledge based questions that any fraudster might know, guess or hack.

ID Verification by ID Scanning. Presenting a valid ID is still a valuable way to prevent fraud. However, checking this manually at the front desk can be time consuming and error prone. Scanning an ID that can be authenticated as valid is quick and easy. Another benefit to scanning is accurate and clean data to populate into your data systems, such as EMR and HER, within seconds. This prevents records with wrong patient data and saves time at patient check-in. It also gives you the ability to verify patients’ identities every time the valid ID is presented.

Protect your Information. Patients must be more careful and pay attention to when and where they share their identity and healthcare insurance information. Anyone with access could be a gateway for fraud. And hackers are very wise about finding information via avenues such as social media to supplement the information they have, like a social security number. Cobbling together a patient profile allows them to present an identity that institutions will accept today.

Final Thoughts

Avoiding healthcare fraud may seem daunting, but it is simpler than you think and solutions exist today that can dramatically reduce the impact. Creating more user-friendly, frictionless ways to verify the identity of patients at every access point will go a long way to protect both healthcare institutions and patients from fraud. Set yourself up with tools that fit your needs, or consult a team of experts on biometric and ID verification security services for an effective and secure way to mitigate healthcare fraud.

 

Read about Carbon Health

Acuant’s Automated Data Capture Solution Selected by Game Changing Carbon Health to Provide a Hassle-Free Digital Experience for Patients

LOS ANGELES, June 6, 2017 /PRNewswire/ — Acuant, a leading provider of data capture and verification solutions, today announced it will provide its AcuFill™ real time intelligent data capture solution to Carbon Health, a mobile-based connected healthcare network that is building a new healthcare system from the ground up.

Carbon Health will incorporate Acuant’s technology into its mobile healthcare platform, which allows patients to connect with all of their healthcare providers through a mobile device. Carbon Health will leverage Acuant’s sleek and easy information capture solution to improve use experience, streamline the revenue cycle, foster better communications within the healthcare ecosystem, and eliminate rejected claims due to manual entry errors.

The unified end-to-end technology platform is integrated with insurance companies, pharmacies, medical imaging centers and labs, providing independent practices with an all-in-one tool to streamline their practice and allowing physicians to spend more time connecting with patients. Patients benefit from a comprehensive healthcare experience accessible through their mobile device, with direct access to their full medical records and seamless continuity of care between virtual and in-person consultations.

“The Carbon Health team brings the best medical experts, designers and engineers together to build a healthcare network that makes sense to both patients and doctors. Acuant has been a key partner from day one, supporting our vision and providing us with a solution that is integral to our seamless user experience for both patients and practices,” said Eren Bali, CEO and Co-founder of Carbon Health. “We look forward to working with the Acuant team as we continue to pursue our mission of transforming the patient-doctor experience.”

“We are excited to partner with innovators like Carbon Health that are disrupting major industries. The healthcare landscape is challenging and ripe with opportunities to have more pleasing patient experiences while also improving operations and costs for practices. That is where our solutions come in and we couldn’t be more pleased to be a part of the new system Carbon Health is creating,” said Yossi Zekri, President and CEO of Acuant. “Our logic-based technology identifies and captures fields regardless of the specific insurance ID template. This infrastructure will enable Carbon to automate patient registration and create a user-friendly experience while guaranteeing the accuracy of data as it relates to patient care, billing and preapprovals.”

About Carbon Health
Carbon Health was founded in 2016 when CEO Eren Bali and co-founders Tom Berry and Dr. Greg Burrell decided to reimagine healthcare by building a completely new healthcare system from the ground up. Carbon brings the marketplace model to healthcare, connecting practices with a unified technology platform and giving patients access to all of their providers through their mobile device. Carbon currently has a primary care clinic in San Francisco and provides virtual care throughout California. More locations coming soon. Please visit carbonhealth.com to learn more.

About Acuant
Acuant Inc. is a global technology company that provides comprehensive Identity Verification solutions responding to various levels of risk and assurance requirements. Utilizing patented technology Acuant transforms data intake into a business-enhancing proposition while instantly reducing the risk of fraudulent transactions.

Acuant’s intelligent engineering is made to work in any industry in any environment with compatibility for Windows, iOS, Android, Hybrid and HTML 5- and built to allow meeting the highest level security requirements and regulations such as KYC, PII, HIPAA and AML. Partners include start-ups, Fortune 500 and FTSE 350 organizations.

Top Healthcare Trends for 2017 Include Telemedicine

This year promises to bring a number of significant changes to the healthcare field. As technology advances and a new administration brings change, the healthcare will continue to move in new directions. A few of the most likely 2017 healthcare trends:

  • Telemedicine explodes

MedCity News reports that last year saw telemedicine accelerate, with more people getting their care through virtual visits. This year, technologies such as cloud-based tools will make it easier than ever to offer excellent health services from afar.

  • New telehealth regulations

As telemedicine moves into the mainstream, practitioners will have to assure that they are in compliance with a growing number of regulations.

Experts say that compliance initiatives and audits will be highly active areas. It is more important than ever for healthcare practitioners to ensure that they are properly safeguarding their patients’ personal data.

  • The end of ObamaCare?

At this writing, Congress is making the moves that will make the sweeping healthcare law a thing of the past. The plans for healthcare laws to replace it are still in the works. Those in the healthcare field will need to keep up with events to know what to expect and what will be expected of them.

 

  • Changes in how we verify insurance

New technology means that it is easier than ever to verify a patient’s insurance and verify what services and medications are covered. Better accuracy means fewer uncovered procedures and fewer unpaid invoices from clients.

  • A better outlook for claim denials

The improvements in verification mean that those in the healthcare field will be taking fewer chances on procedures that are not covered by a patient’s insurance. This leads to higher patient satisfaction with less out of pocket expenses.

In 2017, the Meaningful Use incentive program is replaced by the Advancing Care Information program for those paid by Medicare. The system will give patients more latitude in the technology they use day to day to provide excellent care and to preserve patients’ privacy.

Changes in healthcare laws and preparing for additional regulations relating to patient privacy is a given. But practices and providers can ensure they are prepared for the evolving landscape by utilizing technology based solutions that both add value and meet regulation; all while improving the patient experience.




Self-Service Kiosks for Healthcare