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Catch fraud upfront: Medical identify theft is on the rise
It's time to revamp your processes
If a patient gives a different Social Security number from the last time he or she presented, this could mean that that patient is confusing the number with his or her spouse or child's. However, it could also mean the patient is assuming a false identity.
Nationwide, hospitals are reporting increasing numbers of patients registering under false identities because they lack coverage. This presents many problems for patient access legal, medical, and financial.
"We have seen a significant increase in the amount of identity theft in our organization," says Amy Schroeder, a registration supervisor at BryanLGH Medical Center in Lincoln, NE.
"On average, we have about one case per month that surfaces. Almost all of these cases have presented through the emergency department," she says.
Unfortunately, the financial ramifications can be significant for patient access departments. "We work very closely with local law enforcement to try and identify the perpetrators," says Schroeder. "However, we are often left writing their account balances off."
For some time now, BryanLGH's registrars have scanned patients' driver's licenses into the medical record. "Unfortunately, most patients that perpetrate this crime don't bring their identification," says Schroeder. "We are currently exploring the option of obtaining cameras for the registration areas."
It may be a gut feeling
A red-flag rules screen was created within the registration pathway at BryanLGH. This must be completed on every patient. Allowable values include "V" for victim of identity theft, "P" for perpetrator of identity theft, and "S" for suspicious activity.
If registrars suspect a person may be attempting to assume someone else's identity, they enter an "S" in the computer system and notify their supervisor. For example, a patient may give a different date of birth from a previous visit.
When this occurs, staff are instructed to do their best to obtain a photo identification from the patient to validate identity. If someone is identified as a "V" or "P" on the registration pathway, the registrar always asks for photo identification.
In addition, staff add a comment to the account as to what was suspicious. For instance, the patient may have presented previously but used a different name.
"One of the main things that triggers the registrar that there may be potential fraud is a change in Social Security number or date of birth," says Schroeder. "I would say over 90% of the time it's a gut feeling that they have. They may recognize this person from a visit within the last week and they know they came in as John Smith, but today they are presenting as Joe Johnson."
A notice is sent to a supervisor's printer for follow-up. Once the supervisor receives that notice, he or she starts looking into the electronic medical record to see if there are any photo IDs present from past visits. If the supervisor discovers that a patient has been the victim of identity theft at the medical center, the account is flagged with a "V."
"Once the registrar sees this, they are to do their best to obtain a photo ID," says Schroeder. "If it is discovered that a patient has been the perpetrator of identity theft at the medical center, their account is flagged with a 'P.' The supervisors are the only people that can enter a 'V' or a 'P.'"
Registrars were given training on the new red-flag rule procedure at a recent staff meeting. Each signed a competency log stating that he or she understood the rules, and this was placed in the employee's file.
"Unfortunately, we find that the majority of the time, we are uncovering the identity theft at the time the bill is sent out, rather than catching it upfront," says Schroeder.
Typically, an individual calls the hospital's patient accounts department after receiving a bill and indicates that he or she has never been a patient before. At that point, Schroeder gets involved and contacts the individual to obtain additional information.
"We involve local law enforcement once it's been determined that fraud has occurred," says Schroeder. "The process for untangling these situations is very time-consuming, not only for hospital staff, but for the victims that have to attempt to correct their credit report."
Technology can help
According to Beth Keith, a consultant with Affiliated Computer Services in Dearborn, MI, there are a number of very good systems on the market that allow you to validate information being provided by a patient. These include address verification, electronic verification, electronic credit-checking software, photo ID cards issued by the facility after receipt of verification of identification, and biometric ID systems.
"Any of these efforts will assist in ensuring that you are taking precautions to prevent identity fraud," says Keith.
Since there is growing interest in how to prevent medical fraud, many access departments are establishing policies and procedures to address the red-flag rule requirements. "There is also concern about maintaining positive patient ID for many compliance and liability reasons," says Keith.
However, when it comes to investing in technology, hospitals' "purse strings are still pretty tight," says Keith. "And if the dollars are limited, they are going to the clinical areas to make sure all patient care items have priority." Still, says Keith, "the more you automate the verification process, the more you prevent yourself from being duped into allowing someone to commit identity theft."
[For more information, contact:
Beth Keith, Manager, Healthcare Provider, Consulting, Affiliated Computer Services Inc, 5225 Auto Club Drive, Dearborn, MI 48126. Phone: (985) 845-1559. E-mail: Beth.Keith@acs-inc.com.
Amy Schroeder, Registration Supervisor, BryanLGH Medical Center, Lincoln, NE. Phone: (402) 481-5795. E-mail: Amy.Schroeder@bryanlgh.org.]