Know Your Patient – Eliminating Fraud and Crime in the Healthcare Sector

The digital transformation has reached the healthcare sector with new remote onboarding options for patients. As the digital age creates new opportunities across various industries, there is also an increased risk of fraud and data breaches. A recent HIPAA Journal has reported that there were more data breaches in 2021 compared to any year since 2009. 

It’s not just the breach of patients’ sensitive data that causes problems for the healthcare sector – as subsequent actions like medical fraud and purchase of drugs using someone else’s prescriptions cause serious damage to the institution. Approximately 80 million individuals have been reported to have become victims of data breaches.

Fraud in the Healthcare Sector

Impersonating legitimate patients by stealing or forging identity documents is relatively easier for fraudsters when there is an absence of verification measures like Know Your Patient. Whether it is onboarding new patients or adhering to regulatory obligations by authorities like HIPAA and NHS, medical institutions need to implement these verification measures. KYC (Know Your Customer) is a necessary identity verification measure implemented by banks and financial institutions to prevent becoming victims of fraud and money laundering.

The spike in insurance fraud and prescription fraud in hospitals calls for the mass adoption of Know Your Patient (KYP) to verify their identity and their age. Online identity verification solutions assist medical institutions as well as pharmacies to secure the onboarding of patients and provide them security by protecting their personal information, prescriptions, and test results. Not only that, a robust KYP solution can significantly improve the efficiency of patient authentication.

The Importance of KYP (Know Your Patient) 

Technological advancements have contributed to the development of online platforms for medical institutions where both patients and medical staff, including doctors, can conveniently manage their information and tasks. 

Identity Verification

In light of the increasing fraud rates in the health sector, regulators have ramped up efforts to require online platforms of medical institutions and drug stores to incorporate measures for the verification of patients’ identities. This security measure is beneficial in reducing the number of minors that get addicted to drugs just because they are allowed to purchase them without verification. Furthermore, medication is a sensitive matter that requires extra care, and in case of the wrong dosage or medication, the consequences can be fatal.

According to the Royal Pharmaceutical Society, the lack of age verification measures in pharmacies has enabled minors to purchase drugs using fake prescriptions. The pharmacies simply assume the age of the person by judging that “the child is capable and competent to understand the importance of the medicines they are collecting” and that they are “confident the child will not misuse or tamper with the medicine.” Instead of countering this problem with a robust solution, online platforms of pharmacies have opted for simple web-based forms that the customer has to fill and get approval from the person in charge.

Secure Patient Onboarding

By incorporating a robust KYP solution, pharmacies and medical institutions can prevent minors and fraudsters from getting access to prescribed drugs. Another option to ensure that only legitimate patients are able to purchase medicine is through video KYC, which allows pharmacies to get a better idea about the age of the patient. In most online health platforms, patient onboarding is still a manual process that is not very convenient for either of the parties. As online systems are designed to cut down on the errors made due to human intervention, KYP solutions can further increase the efficiency of hospital systems. As a result, medical institutions can improve their system by reducing the time spent on rejected insurance claims. 

With today’s robust KYP solutions, patient information can be verified through their ID documents as well as insurance cards, passports, or driver’s licenses. It takes mere seconds to verify the patient and significantly reduces the time taken to onboard patients. In case the medical institution fails to protect the sensitive personal information of patients, they risk getting their reputation stained. The safekeeping and continuous updating of patient records are mandatory for every medical institution as it allows them to provide better services to the patients. When the information of patients is not secure, cyber attackers like malicious hackers can breach the system and make changes that can prove quite harmful to the patient’s health.

How to Implement a KYP Solution

The healthcare sector can eliminate fraudulent entities and address the issue of convenience by incorporating a Know Your Patient process that follows a few basic steps. It begins by requiring a scanned copy of the patient’s government-issued identity document, which can be their ID card, passport, or driver’s license. The patient has to simply send the scan via the medical institution’s identity verification platform, followed by a selfie which the system uses to verify their identity using biometrics. The selfie is matched against the photo of the patient on their ID document. The system also verifies whether the ID document provided by the patient is original by matching numerous templates with the help of machine learning algorithms. 

Similarly, the age requirement for the prescribed drugs is verified accordingly against the patient’s actual age as per their ID documents. This helps the medical institute to detect fraudulent activities and prevent data breaches.

The above mentioned key steps are considered significant to secure the healthcare industry, assisting companies to protect patient data integrity and helping to maintain trustworthiness in the market. It’s viable for medical institutions, yet it fails to integrate such tech-driven solutions which makes them vulnerable to crimes.

What Shufti Offers

Securing the healthcare industry is becoming a global concern and the sector is in dire need of integrating automated identity verification solutions. This will assist them in onboarding legit patients and fighting medical fraud including patient identity theft, false insurance claims and much more. Know Your Patient verification regulations are considered critical for safeguarding the medicare industry’s integrity. 

Shufti’s Know Your Patient (KYP) verification service is the ideal solution to counter identity fraud in the health industry. Shufti’s identity verification solution removes the friction and increases transparency, making the onboarding process seamless. Powered with thousands of AI models, ID verification services help to curb the risk of criminal attempts and assist to stay put with the ever-evolving regulatory regime.

Want to know more about our KYP solution for the health industry?