Avoid 3 Major Healthcare Industry Challenges with Identity Proofing

By David Thomas 

As virtual care and digital patient experiences become commonplace for patient acquisition and retention, technology is forcing the healthcare industry to consider new ways to verify patient identity, and to integrate comprehensive identity verification – or “identity proofing” – into every touchpoint of the care continuum.

Beyond simply knowing with confidence that a patient is who they claim to be, identity proofing is also key to mitigating fraud, which, according to The Institute of Medicine, costs the U.S. healthcare system more than $75 billion annually.

There are extremely important reasons to implement rigorous identity proofing for major players in the healthcare industry: 

• Providers need to know a patient’s identity to access their relevant medical and treatment histories, and to ensure consistent and appropriate care.
• Patients need documentation to prove insurance and other enrollments that support medical expenses.
• Administrators and Researchers need patient identifiers to generate statistics and data for planning, evaluating, emergency response, improved treatments, and disease management.
• Health Insurers need to be able to verify a patient’s healthcare coverage and facilitate claims adjudication based on the patient’s history.

Identity proofing can help diminish, if not eliminate, fraud that results from three major challenges that regularly impact a wide range of clinical and financial operations in the healthcare industry:

1. Duplicate Records
2. Medical Identity Theft
3. Payment Fraud

Duplicate Records

About 5-10% of all stored medical records are duplicates. Duplicate medical records, which occur when a patient is associated with more than one medical record, are a result of patient identification errors. The potential for fraud emerges when a patient’s “partial duplicate record,” that only captures a portion of their medical history, is overwritten with data from another patient’s record, creating a combined, inaccurate record.

Medical Identity Theft

Medical identity theft costs the United States $84 billion annually, forcing organizations to innovate the entire healthcare system and develop customized solutions from check-in and discharge to patient rooms, labs, and data centers. With increased instances medical identity theft comes escalated misdiagnoses, ineffective treatment plans, and, unsurprisingly, payment fraud.

Payment Fraud

More than $272 billion is lost to healthcare fraud and abuse annually from Medicare and Medicaid alone (not accounting for finances lost from private healthcare fraud.) Payment fraud is a byproduct of medical identity theft wherein either an individual’s identity is misrepresented, or their identity is accurate, but their payment is fraudulent.

Each of the aforementioned challenges can be alleviated, if not bypassed entirely, when healthcare organizations leverage identity proofing. Verifying a patient’s identity upfront can help consolidate the amount of records attached to that individual, reduce instances of medical identity fraud, and can even mitigate payment fraud.

In today’s digital world, the name of the game is providing patients with digital experiences that are simple and easy to use. The recent shift in customer expectations has prompted healthcare industry companies to implement automated identity proofing technology that is accurate, safe, and require little back-and-forth. As a healthcare organization, it is important to offer modern, intuitive account registration that can quickly verify a patient’s identity to provide them with secure digital access to their medical records, physician messaging, appointment scheduling, lab results, prescription refills, and more.

David Thomas is CEO of Evident ID.  David is an accomplished cybersecurity entrepreneur, having held key leadership roles at market-pioneers Motorola, AirDefense, VeriSign, and SecureIT. He has a history of introducing innovative technologies, establishing them in the market, and driving growth – with each early-stage company emerging as the market leader. After being recruited at a young age by the Department of Defense, David has been at the forefront of cybersecurity including firewalls as corporations began connecting to the Internet, web security as online shopping emerged, wireless security as Wi-Fi and smartphones became ubiquitous, and security sensing networks as analytic technology became mainstream. His expertise has been featured in CNN, The Wall Street Journal and other leading publications. David sees cybersecurity as the key ingredient to enable trustworthy and fast interconnectivity between the billions of people and devices that will soon be constantly connected. 

Evident is revolutionizing the way personal data is shared. Evident’s simple, secure Identity Assurance Platform lets businesses confidently know who they are dealing with without handling sensitive personal data. With connections to thousands of authoritative sources through a single API, Evident is the only platform that enables comprehensive, accurate, and up-to-date identity and credential verifications without the risk and liability of holding personal information.