Know Your Patient – Balancing Security, Customer Experience and Compliance in the Healthcare Sector

As the healthcare industry continues to offer life-critical services while making efforts to improve treatment and patient care with new technologies, cybercriminals are looking for ways to exploit the vulnerabilities that are coupled with these changes. Due to this reason, the healthcare industry is plagued by a myriad of cybersecurity-related issues including identity theft, false insurance claims and much more.  

Fraudsters cause serious damage to healthcare organisations by breaching patients’ data and using it for actions like medical fraud. On the contrary, verified and secured patient services have been assisting healthcare institutions in maintaining a fraud-free environment with the help of efficacious Know Your Patient (KYP) services. Thus, the healthcare industry needs to integrate KYP solutions to safeguard their operation while ensuring fool-proof services to make the customer experience seamless.

Need of Verifying Patient Identity To Meet Compliance

Health-related information is kept confidential due to its vulnerability to criminal activity. Healthcare personnel have a basic right to know who they are treating, and once they have all the necessary information regarding the patient, it is their moral and legal duty to keep the records confidential and secure.

1. Preventing Medical Identity Theft

Since healthcare is extremely expensive without insurance, the cost becomes a vibrant stimulus for bad actors to steal patients’ identities. As a result, they can take advantage of patients’ Personal Identifiable Information (PII) to get medical services and treatments.

According to a study conducted in the US, around 300 medical sector breaches were reported exposing the private records of 171 million patients. The median cost due to regular identity theft to a victim is $55. Loss of insurance money, potential harm to credit ratings, and charges due to drug abuse activity are some of the other problems that a victim may experience. 

2. Securing Patient Identity 

There are certain laws and standards set by the Health Insurance Portability and Accountability Act (HIPAA) and various other regulatory authorities to secure patient data and the reputation of medical centres. The key purpose of these regulations is to mandate the healthcare industry to gather, maintain, and secure patients’ medical records electronically while preserving the integrity of those records in real-time. As required by HIPAA compliance standards, companies that keep records of health information (HI) are supposed to have ideal privacy protections in place to secure all forms of patient data like emails, test reports, treatment history, etc.  

3. Minimising Imprecise Medical Information

Another problem that the healthcare sector faces is inaccurate information being put on someone else’s medical records. So, ensuring precise patient identity information at the beginning of treatment would help minimise undue losses as a result of fraudulent activities. 

Real-Time Crime Cases in the Healthcare Industry

Like, the financial industry and other sectors prone to cybercriminal activities, The Healthcare industry is also becoming a victim of fraudsters, putting the reputation of the whole industry at stake. 

Here are some specific recent examples of fraud in the US Healthcare sector:

1. Chiropractor Charged for Fraud in Florida

A chiropractor was charged for obtaining fraudulent loans from COVID-19 relief programs and fallacious claims for refunds from medicare centres. According to the Justice Department, the chiropractor (Dennis Nobbe), was intentionally planning to exploit patients by the name of a credit card program to influence them to pay out of pocket for medical care. Nobbe also bribed other healthcare personnel to open credit card trade accounts in their own name. He was successful in obtaining over $200,000 in an Economic Injury Disaster Loan, which was intended to provide relief to the businesses affected by COVID-19.

2. $681M Fraud in Healthcare in Florida

The Justice Department stated Micheal J. Ligotti, a healthcare personnel, was charged with committing healthcare fraud. He was caught allegedly engaging in billing for examinations and medicine that included patients’ drugs and alcohol addiction rehabilitation.

According to criminal records, Ligotti was charged with having penalty orders for hundreds of dollars in urinalysis tests. He often paid kickbacks to addiction treatment centres in return for taking his patients under treatment. The scheme resulted in $681 million in fraudulent lab testing assertions. 

Preventing Fraud in Healthcare Organizations with a KYP Program

As Know your customer compliance has helped financial firms and other sectors to fight fraud and secure operations while ensuring authentic customer onboarding, similarly,  Know Your Patient (KYP) is becoming pivotal for healthcare organisations. KYP is essential to ensure smooth patient onboarding and to safeguard against medicare crimes. Digital Know Your Patient solutions assist healthcare centres and service providers in preventing any sort of fraudulent activities.

Before starting a patient’s treatment, healthcare providers are acquired to verify their identity to make sure that legitimate patients get enrolled, minimising the risk of illicit digital activity linked with patients.

Thus, medical institutions are required to gather the Personally Identifiable Information (PII) of the patients, such as health insurance ID and other information to get accurate verification results. Furthermore, healthcare centres also need to make risk profiles to limit the chances of identity fraud and other financial crimes. To do so, SaaS companies have come up with KYP screening solutions that help companies to determine the patient’s true identities while ensuring seamless services in real-time.

Implementation of KYP in the Healthcare Sector

In consideration of all the fraud occurring in the healthcare sector, KYP implementation has become irresistible for organisations to keep criminals away. Having an effective KYP system is the only solution through which the medical industry can confidently keep track of their patient’s records. Robust KYP measures will not only assist in protecting the identity of patients but will also mitigate monetary losses to the organisations.

Financial fraud is surging in the medical sector, predicted to reach $6.6 billion by the end of 2028, showing a 23% CAGR. With the help of KYP solutions, medical organisations will only allow the onboarding of authentic patients to reduce the financial crime rate. Due to weak identity verification measures, fraudsters easily manage to exploit healthcare databases, exposing almost all the stakeholders associated with this industry to financial losses or other severe consequences. Therefore, it is viable for medical centres to implement Know Your Patient (KYP) solutions into their systems in order to restrict criminals while ensuring seamless and foolproof digital health services.

Key Takeaways

Securing the medical sector has become a global issue globally and there is a dire need to incorporate automated IDV solutions. Doing so will assist them in considering only genuine patients and combating healthcare scams such as patient identity theft and fallacious insurance claims. Know Your Patient verification solutions are considered crucial for protecting the healthcare industry’s integrity.

Shufti’s Know Your Patient service is the absolute solution to fight identity fraud in medical institutions. Shufti’s identity verification solution eliminates the trust hurdle and accelerates transparency, ensuring the onboarding process is smooth. 

Powered by an AI model, Shufti’s ID Verification Services assist in exempting the probability of criminal attacks and help to stay updated with the ever-evolving regulations.

Would you like to learn more about Shufti’s KYP solution for the healthcare industry?