How AI is Transforming Fraud Prevention in the Healthcare Industry

Richard Marley
December 01, 2017
3 minutes read
3603

KYC For HealthCare: Fraud is so common that there is hardly any industry that hasn’t had to bear the brunt of it. The health care industry is no exception to fraud. Medical identity fraud has some of the worst impacts on a person’s life. The financial shock alone is enough to be devastating for the victim. The emotional shock, on top of that, is significant when a person gets their medical identity stolen. The medical institution itself faces problems due to the type of fraud discussed herein. Medical identity theft is rising fast and becoming a concern for both patients and healthcare providers. However, modern technology has transformed fraud prevention in healthcare and is enabling the fight against fraud significantly.

In the past few years, medical identity theft has risen significantly. In 2016, around 10% of the US population had their medical data compromised. Due in part to the fact that the number of data breaches in the past few years has increased exponentially. Healthcare data fetches at least 10 to 20 times more on the black market than normal identity credentials. This makes medical data more appealing for hackers and cybercriminals. The primary reason being the fact that medical records contain more information than other identity documents, including name, DOB, SSN and insurance information. What is worse is the fact that is harder to detect as it can go unnoticed until a person needs medical services.

Source: Experian

Fraud in the healthcare industry via impersonating a person is something where some people even go so far as to copy credit cards of another person and make payments using them. Fraudsters are also known to use medical insurance details of a person to obtain healthcare benefits or buy prescription drugs. Any of these situations can prove to be seriously harmful to the victim. Not to mention that it can cause grave damage to a person’s reputation.

Using AI for Fraud Prevention in Healthcare

Where AI has made immense progress over the years, it has also managed to improve fraud prevention systems. The same fraud prevention systems can be used to address fraud in healthcare systems. There are a number of third-party identity verification service provider. These digital KYC systems use advanced AI and HI (Human Intelligence) to pick up fraudulent attempts.

Online identity verification services authenticate individual users through document and facial verification techniques. This allows them to determine if a person is using fake or stolen credentials and thwart their attempts to defraud the system.

How Do Fraud Prevention Systems Work?

Third-party fraud prevention solutions like Shufti Pro rely on AI and HI to look out for false positives. Simple access to the internet, a web camera or a smartphone camera enables users to carry out an identity verification check. The hospital staff simply would have requested the patient to use the camera to verify their ID and/or insurance card, while authenticating them by using facial verification.

Fraud can be prevented by us being a little more vigilant and careful with our personal information. At the same time, the various institutions that provide healthcare and handle payments need to be a bit more strict with their KYC processes. They can third-party verifiers effectively to their advantage to build fraud prevention in healthcare systems.

Disclaimer: No warranty is herein provided that the information contained in this document is accurate, up-to-date, and/or complete. In no circumstance(s), does such information constitute legal or any other advice. Any person who intends to use, rely, pass-on, or re-publish the information contained herein in any way is solely responsible for the same. We suggest to verify the information and/or obtain expert advice independently if required.

Latest News

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ASIC Expands its Team to Enhance Cryptocurrency Regulations
Using AI for Fraud Prevention in Healthcare
How Do Fraud Prevention Systems Work?
Australia’s financial regulator has enhanced the size of its crypto team. The crypto regulatory measures include their application for financial services licenses and show that specific crypto platforms have particular liquidity in reserve.

After shifting popular blockchain from a proof-of-work (PoW) to a proof-of-stake (PoS) system, ASIC, Australia’s financial regulator, has increased the size of its crypto team.

U.S. Security and Exchange Commission Chairman Gary Gensler stated that PoS-based tokens might be classified as securities.

The decision of ASIC to keep PoS tokens for example Ethereum, Cardano and Solana under its remit will further clarify the situation and enable crypto regulations to be more effective. To cope with the latest regulatory reforms, the crypto exchange must either delist the tokens or start complying with robust crypto laws.

Such moves may force a few crypto firms to manage their operating models. Even the largest stablecoin of the crypto market, Tether, has been caught in a controversy created over the failure of holding enough dollar reserves to back the stablecoin.

The crypto regulatory measures include their application for financial services licenses and show that these platforms have particular liquidity in reserve.

The final decision by the regulator has not been issued yet. Greg Yanco, the executive director for marketers, said that ASIC won’t be a “cheerleader for crypto assets.”

SEC Newgate carried out research the last November. It showed that 44% of Australian retail investors reported holding crypto. Out of these investors, only 20% viewed crypto as high-risk.

The chairperson of ASIC responded and said that the regulators were “concerned that there are limited protections for crypto-asset investments given they have become increasingly mainstream and are heavily advertised and promoted. There is a strong case for regulating crypto-assets to better protect investors.”

According to Yanco, until the last year, cryptocurrency was not such a high priority. Still, due to the decline of cryptocurrency in the previous few years and investors wiped out around the globe, ASIC expanded its team. It made crypto one of its “core strategic projects.”

Suggested Read: Regulatory Authorities to File a New Bill to Secure the Citizens from Cyber Criminal Activities

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Prevailing Crimes in Identity Verification - How Shufti Pro’s Forensic Document Verification Can Help
Using AI for Fraud Prevention in Healthcare
How Do Fraud Prevention Systems Work?
Identity fraud has become quite prevalent in digital businesses which is not only affecting operations but also raising concerns about money laundering and other financial crimes. While using any online service, users have to input their confidential details mainly name, ID number, address, and social security which elevates the risks of cybercrime. On the other hand, it has also become a huge challenge for digital service providers to verify all their customers and keep their information secure. The criminals use a variety of sophisticated techniques, particularly document forgery to disguise their identities and get involved in financial crimes.

Although all digital businesses are working tirelessly to eliminate the chances of document fraud, it is still prevalent and numbers are rising every year. In the US alone, there was a 68% increase in the cases of data compromises compared to the previous year with insurance companies as the main target of scammers. Documents are the most crucial sources of verifying the identities of users and it is important for online service providers to implement an advanced system of record checkings like Optical Character Recognition (OCR) and forensic document authentication.

Forensic Document Verification – A New Standard

The emerging technologies have not only helped businesses to secure their operations but also encouraged fraudsters to use more advanced techniques of exploiting loopholes in systems. The majority of digital service providers like Payoneer, Paypal, Amazon, Walmart, and many others have implemented stringent regulations to verify the documents of their users but traditional methods are not serving the purpose of authenticating the true identities of customers. In the UK alone, consumers lost £1.3 billion in 2021 which is 27% more compared to the previous year. Undoubtedly, it can be established that prevailing document verification measures are not efficient enough to curb sophisticated fraud methods used by criminals. The whole system is in dire need of forensic authentication which is more advanced and has all capacity to counter scammers.

All the digital service providers particularly financial companies, educational institutions, and immigration departments are at high risk of document fraud. The criminals use forged documents to claim funds, admissions to universities, or entry to foreign countries. By implementing standards of forensic forgery detection, all online businesses can secure their onboarding system with very less risks of scams. The forensic authentication of documents involves scientific techniques to verify the identities of users leaving no room for criminals.

How Forensic Document Verification is Carried Out?

Forensic document verification involves incorporation of scientific rules in examining the authenticity of records. There are experts in this field who carry out all the operations using specialized methods. Nowadays, the use of forensics is rising, especially in courts where no document is accepted without authentication. By using several techniques like handwriting identification, ultraviolet light sources, microscopes, photography, and infrared imaging in the laboratories, a document is verified. All the major jurisdictions have formed dedicated institutions which overlook the process of document verification. The American Board of Forensic Document Examiners (ABFDE) is the primary authoritative body responsible for monitoring forensic operations in the US, and any person carrying out these activities anywhere in the country must be a member of this board.

High-Profile Crime Cases of Document Fraud

The prevailing traditional methods of document verification have encouraged criminals to exploit loopholes in systems inflicting financial losses on users. In the recent past, several cases have surfaced where scammers try to manipulate documents resulting in credit card fraud, illegal immigration, fake admissions to international universities, and many others. Let’s have a look at some of the high-profile cases of document fraud in different countries.

Gang Arrested for Printing Fake Documents in Greece

European Police conducted a raid this year dismantling a criminal network involved in forgery and dissemination of counterfeit documents. The gang was using fake identities and helping people to apply for immigration in several European countries. The Police have seized 362 forged documents including ID cards, residence permits, passports, and asylum papers which were used in carrying out illicit activities. The law enforcement authorities have stated that criminals had support from other countries and investigations are still going on to catch all culprits.

Criminal Network Busted for Distributing Fake Documents

French law enforcement agencies along with Spanish Police cracked down on a gang that was involved in the distribution of forged ID and travel documents in several countries including France, Germany, Italy, and Spain. The raid resulted in 17 arrests and the seizure of a large number of fake identity records. It has further been stated by Police that criminals were involved in the smuggling of migrants to the US, UK, and Ireland while carrying out drug trafficking as well. The investigative authorities are still working to find more proof against criminals to penalize them as per law.

Regulatory Authorities Monitoring Document Fraud

The Financial Action Task Force (FATF), the primary body working against money laundering, has also highlighted the importance of effective document verification measures in curbing monetary crimes. In the wake of this, several countries across the globe have legislated and implemented stringent solutions to verify the true identities of users while onboarding.

Canada

Canada is among those countries that have pretty rigid approaches toward document fraud. Section 366, 367, and 368 of the Criminal Code of Canada terms record forgery as a criminal offense. The maximum penalty for this crime is 14 years imprisonment including heft fines. The law-enforcement authorities in Canada have charged several criminals under this act and set an example for fraudsters.

Australia

Section 83A of Crimes Act Australia states “A person must not make a false document with the intention that he or she, or another person, shall use it to induce another person to accept it as genuine, and by reason of so accepting it to do or not to do some act to that other person’s, or to another person’s prejudice.” The maximum penalty for any crime related to document forgery is 10 years imprisonment which can vary depending on the nature of crime.

Document Forgery Forensic Authentication – Ensuring KYC Compliance

Documents are considered the foremost source of verifying the identity of any person. Any type of fraud related to official records can inflict serious consequences on individuals and businesses. It is crucial for online service providers to implement stringent measures to ensure Know Your Customer (KYC) compliance for their users. By implementing document forensic technology, the legitimacy of documents can be checked using advanced ways of securing digital businesses. It will not only help in countering criminals but also ensure global compliance.

What Shufti Pro Offers?

Shufti Pro’s state-of-the-art identity verification services can help online businesses implement a robust solution against document fraud. Combating financial crimes through efficient record authentication will secure the identities of users and ensure compliance with global regulatory standards. Powered by thousands of AI algorithms Shufti Pro’s KYC solution uses advanced techniques like OCR and forensic document examination to verify documents in real-time. It generates output in less than a second with 98.67% accuracy.

Want to know more about forensic forgery analysis of documents for digital businesses?

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How AI is Transforming Fraud Prevention in the Healthcare Industry

Using AI for Fraud Prevention in Healthcare

How Do Fraud Prevention Systems Work?

Forensic Document Verification – A New Standard

How Forensic Document Verification is Carried Out?

High-Profile Crime Cases of Document Fraud

Gang Arrested for Printing Fake Documents in Greece

Criminal Network Busted for Distributing Fake Documents

Regulatory Authorities Monitoring Document Fraud

Canada

Australia

Document Forgery Forensic Authentication – Ensuring KYC Compliance

What Shufti Pro Offers?

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Let’s prove your customer’s

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