The healthcare sector deals with the most sensitive data and holds a complex structure to secure them. However, fraudsters deploy various techniques to steal these details for availing illegitimate medical benefits. One among many fraudulent activities imposters use is false insurance claims to back treatments. Similarly, synthetic identities help them steer clear of patient verification checks and commit prescription fraud.
Healthcare providers need to integrate efficient mechanisms to identify patients. Telemedicine is bringing innovations by providing virtual check-ups, instant access to records, and online purchase of drugs. Therefore, it has become a liability for medicare centers to ensure they are not assisting importers. Furthermore, regulatory bodies are also placing strict regulations in place. This blog provides an overview of patient verification standards.
Global Patient Identity Verification Standards for Medicare Services Providers
As it may indicate, the healthcare sector does not only include clinics, OPDs, or hospitals, pharmacies, nursing care centers, and other such medicare service providers also add in. Furthermore, all of these face identity fraud, false insurance claims, and other medical scams at some stage. For instance, doctors might detect synthetic fraud during virtual checks and pharmacies deal with fake prescriptions while selling drugs online.
Keeping the increase in fraud risks under consideration, global regulatory watchdogs are toughening their stance toward patient verification. As per guidelines, medicare providers should validate individual’s identity applying for treatments, keep their records up to date, and protect them against external breaches. More details regarding the global identifying patient standards are in the next section:
HITECH – The Health Information Technology for Economic and Clinical Health Act
HITECH standardizes data keeping in electronic forms to help individuals access their records remotely. Similarly, it also provides guidelines for medicare service providers regarding how to digitize medical records and incorporate technology in online their operations. This know your patient regulation came into force in 2009 with the prime purpose to overcome and minimize concerns raised by individuals regarding medical assistance and the healthcare sector at large.
With another purpose to serve, HITECH also strengthens approach of the US’s HIPAA act. Moving further, the Health and Human Service Office for Civil Rights (OCR) also comes under the jurisdiction of this regulatory obligation. HITECH further mandates this organization to provide better data security while performing efficient patient verification for limiting unauthorized access.
OCR is responsible for regulating medicare facilities and in case of non-compliance with identifying patient requirements, it can impose penalties of around $1.5 million per annum.
HIPAA – Health Insurance Portability and Accountability Act
Coming into effect on August 21, 1996, the HIPAA has its recognition as a federal law with the purpose to mandate healthcare centers verify patient identity and safeguard their medical e-records. Furhtmroe, by applying this regulation, authorities oblige medicare providers to obtain consent before granting access to confidential information. Fraudsters often create synthetic identities to get their hands on patients’ details and in turn use them for their personal benefits.
HIPAA is ascended by the know your patient Privacy Rule with an aim to strengthen the application of the former. As per the guidelines, medical care providers need to perform accurate patient age verification along with identity validation. Moreover, they should brief individuals regarding how they can remotely access and use their records. Safeguarding databases against criminal breaches is another liability for the healthcare sector.
CMS – Centres for Medicare and Medicaid Services
Put forth in 1965, CMS is responsible for monitoring medicare service providers. The agency comes under the direction of the Department of Health and Human Services (HHS). It further ensures that pharmacies, hospitals, and their affiliates are adhering to patient verification regulations.
CMS supervises healthcare centers within its jurisdiction to make sure they are validating patient identity prior to allocating any treatments. Similarly, it obliges medical officials to efficiently differentiate between imposters. In case of suspicious activity or fraud risks, they should report to legal authorities in time.
As the healthcare sector is on the verge of falling victim to fraud risks such as cyberattacks, identity theft, illegitimate access benefits, and false treatment claims, CMS is outlining know your patient guidelines for them to prevent such threats. It also stresses the integration of Electronic Health Records (ENR) to provide individuals with easy access and limit inaccurate entries.
In the End
The medicare sector is undergoing a noticeable increase in synthetic identity fraud, prescription scams, false insurance claims, and other criminal threats. Keeping these in view, regulatory bodies from around the globe are putting necessary actions in place to combat scams. As per guidelines by legal standards, the healthcare sector and all of its affiliates need to establish efficient patient verification mechanisms. To further secure medical e-records, they need to bring in preventive measures for restricting criminal breaches.