Know Your Patient – Eliminating Identity Fraud in the Medical Sector

Know Your Patient – Eliminating Identity Fraud in the Medical Sector

Healthcare is in charge of managing and keeping the most confidential information. As a result of the pandemic and concomitant digitalization, it has been obliged to change its operational methods. From online prescription sales to digital visits, the healthcare business is facing a wave of transformation. However, these convenience-driven adjustments provide access possibilities for fraudsters. They employ a variety of techniques to get fraudulent healthcare benefits. As a result, medical facilities must use patient identification methods to ensure that only approved patients request benefits. The same is true for records that have not been validated. As a result, in order to adhere to legislation and protect public health, the healthcare business must employ dependable identifying patient systems. Additionally, the blog offers additional online information about Know Your Patient regulations.

Procedures to Verify Patient Identity 

In the digital age, patient verification is now a stringent regulatory requirement rather than just a safety measure. Since the healthcare industry began to offer virtual assistance, con artists have adapted cutting-edge techniques to profit from medical services. Cybercriminals also carry out data breaches in locations where patients’ electronic records are readily accessible. By doing this, they are able to gather trustworthy information that they can then use to submit fictitious insurance claims, collect money, and pay for pricey treatments. 

Regulatory bodies are changing their positions on the Know Your Patient requirements in response to this rise. HITECH, HIPAA, and EMTALA are just a few strict laws they enforce. Medical facilities must identify patients and safeguard their digital records in accordance with the guildies. They need to include workable solutions for this. Utilizing the AI-driven patient verification services requires users to go through the following steps to confirm their identity:

  1. In the initial step, the system displays an online form that requests patients’ personally identifiable information.
  2. Users have both the options to upload images of their documents or to physically present them to the camera after entering their information. 
  3. The OCR tools extract information from documents during the third stage of the patient verification process, and the system then examines those documents to look for forgery indicators. 
  4. After that, the system analyzes facial features and verifies the patient identity by comparing the information from the form with any uploaded documents. 
  5. The system executes liveness detection checks to verify that the patients are actually present behind the screen.
  6. In addition to other checks, the system also verifies the patient’s age.
  7. If the findings are reliable, they are displayed on the screen, entered into the patient’s file, and made available to authorized patients.

3 Benefits of Online Patient Verification

Healthcare service providers are turning to virtual assistance to address patients’ concerns and preserve their health. Doctors can make house calls for patients, who can also order medications online and save money. But more significant problems come along with these developments as well. Tools for patient verification are, therefore, essential in Medicare centers. Additionally, there are the following benefits:

  1. Patient Tracking and Monitoring

Other advantages of finding patient remedies online include tracking and monitoring their activities. The manner in which healthcare facilities deliver medical aid is evolving. EHRs and telemedicine, for instance, are altering how the healthcare sector operates. On the other hand, con artists and minors, on the other hand, utilize sophisticated ways to profit and deny legal consumers their rights. As a result, to avoid fraud, healthcare providers must develop procedures for identity validation and patient age verification.

  1. Data Privacy

If Medicare facilities don’t have effective patient verification methods, external breaches are more likely to occur. Fraudsters steal information from medical records, access it illegally, and then use it to their advantage. In a similar way, patients moving to different locations for better care increases data vulnerability. 

In order to combat these problems, healthcare professionals need AI-driven tools that can verify patient identity. Additionally, they offer up-to-date record keeping, which reduces the likelihood of a misdiagnosis.

  1. Decreases Physical Visits

With the advent of telehealth and online health assistance, the healthcare industry is operating differently than it was previously. Both online pharmacies and virtual consultations have replaced traditional consultative settings. Fraudsters use actual patients’ identities and payment details to purchase drugs and access healthcare. 

Therefore, ID verification for pharmacies is compulsory to conduct real-time authentication. During the onboarding process, scammers can be found with the help of AI-driven patient verification methods.

Key Takeaways

There is an increasing need to defend the healthcare sector against threats from outside fraud. Even though digitization has some risks, tools for patient verification powered by AI help to restrict access for fraudsters. Regulating authorities are enforcing laws and carrying out regular inspections to ensure this takes place in every way. To maintain standards and provide better patient experiences, the healthcare industry must integrate automated Know Your Patient methods.

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