Know Your Patient: Verifying Patient’s Medical Identity to Prevent Fraud


From 2009 to 2020, almost 3,705 data breaches occurred in the healthcare industry and most of these breaches happened due to theft, loss, or exposure. This is equivalent to 81.72% of the US population getting affected.

Cybercriminals affected the medical records of 143 million patients in 2017 that far exceed the value of stolen credit cards. Healthcare providers often leave patient's medical records exposed that are stolen easily by criminals. Although, given the tremendous growth of identity theft - criminals find it easy to make themselves seem like legitimate patients. This is the reason, health care providers need to properly vet their patients to make sure their patients are who they claim to be.

Know Your Patient correlates with the KYP requirements of financial industries that usually involves carefully considering methods pertaining to identity verification and due diligence. Therefore, it's important for the medical facilities to verify patient healthcare ID and comply with regulations such as HIPAA. Medical centers can prevent heavy fines and penalties by meeting Know Your Patient (KYP) requirements.

Moreover, the Healthcare industry is fragmented into separate parties that deal with different data requirements to provide patient care. Therefore, each party requires to know the person’s real identity for treating all patients correctly. The medical information is highly confidential and is shared only with the most relevant healthcare providers. Because keeping up to date and accurate data is vital that affects patient’s treatments and their recovery.

Consideration For Patient Identification

Nowadays, healthcare centers vary in how they collect information to verify patient identity. Moreover, countries around the globe use patient identifiers to assist with patient identification while in the United States it's prohibited to use UPI due to privacy concerns.

As healthcare data continues to grow, challenges posed with healthcare data can be minimized through the accurate matching of data with the patient's health. It would ensure patient’s safety and security while making sure that all resources are appropriately used.

The errors during the patient identification have various implications on patient care, safety, payment, and Know Your Patient regulations. However, with advancements in technology, there is no solution that can provide a 100% match. But optimizing the algorithm matching with an identity verification tool could provide an enhancement in patient identification. Moreover, to improve the patient eligibility verification, healthcare providers can adopt patient photos during the registration and standardized processes to keep up-to-date patient demographic data.

Therefore, it's important for the healthcare industry to practice different technological approaches or practices to gain operational excellence. This would help the organization to meet Know Your Patient regulations and avoid stolen patient IDs.

Protecting Yourself From Medical Identity Theft

It’s a widely known fact that the medical cost is unrealistically high that can turn-out to be even more expensive if it's not covered by insurance. Therefore, this cost provides a high incentive to criminals for committing medical identity theft. It usually involves illegal access or use of a patient's personal information for obtaining medical treatment or goods.

However, as proven through several years that there is no single way to keep your information secure, here are few basic steps to avoid medical identity fraud.

       Make sure to go through all notices provided by health planners like doctors or pharmacies.

       In-case if your medical information gets stolen or lost - you can ask to get a new card along with the health insurance identification number.

       You should avoid sharing your health care information with another person or a company that is claiming to provide free products or services.

       If someone tries to initiate a conversation over the phone call or through an email - never share your information unless or until you have confirmation that the person on the other end isn’t a fraudster.

       Make sure to properly dispose of the documents, containing your personal information.

       Constantly monitor unpaid bills in your credit because it might hurt your credit history.

       Almost once every year, make sure to check your medical records.

       Ensure keeping few copies of the medical records as proof of information.

You would want to add similar practices that might already be in use for avoiding various types of identity theft. It involves using a unique password with your online medical accounts. 

To digitize the initiatives in the healthcare industry - more effective methods with identity verification are required. Integrating a sophisticated solution would help with a quick and seamless experience that can ease the onboarding of new patients for changing insurance coverage. It would not only help healthcare industries to improve patient experience but would also ensure compliance with Know Your Patient (KYP) regulations. This way, industries can also avoid any fraudulent activity. 

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