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.