Healthcare fraud, waste, and abuse cost taxpayers billions of dollars. According to a report published in BusinessWire, the global healthcare fraud analytic market may reach US$ 5.69 billion by 2027. Detection of fraud leads to hefty fines, criminal proceedings, and incarceration for the concerned individuals in organizations. 2021 saw a peaking of medical fraud and abuse, according to the latest report of the HIPAA journal.
As the world is becoming rapidly digital, market growth is attributed to the increasing fraud in healthcare, especially health insurance and pharmacy-related claims. Implementing KYP (Know you Patient) procedures checks this rapid digitalization and fraudulent activities. Healthcare providers are now diligent in implementing processes in their organizations to prevent medical fraud.
Various methods by which healthcare fraud is committed.
Medical fraud occurs due to cyber criminals and other hackers who have purchased stolen data on the dark web, using this data to impersonate legitimate patients. . Common insurance frauds include:
- The Patient’s medical data is fraudulently used to obtain reimbursement from healthcare insurance companies. Such frauds can be committed by both employees and hackers who have stolen the Patient’s data.
- Committing theft through identity fraud by falsely claiming reimbursement for procedures never performed on the Patient.
- Cybercriminals steal the Patient’s data through identity theft and misuse the information of the original Patient to get prescriptions and medicines they are not authorized to do.
- Patients are damaged due to the above as insurance premiums increase with the increased cost of coverage, reduced credit ratings and, in some cases, even denial of services and coverage.
- Patients can guard against the above forms of identity theft by checking credit reports, monitoring insurance premiums and protecting private information.
Know Your Patient is a modified form of Know Your Client or KYC. It verifies the Client’s identity through a process of the Patient’s Identity screening. Know your patient procedures allow healthcare organizations to check on the prescriptions and insurance plans and protect the patients from the negative consequences of negative financial and identity theft.
The KYP Process
KYP usually begins with an identity screening and age verification of the Patient on the website or web portal of the pharmacy. The Patient shows his identity documents through a selfie camera or a web camera. The AI system scans the same and matches it to the Patient’s identity demonstrated at the time of the patient registration. The identity screening solution eliminates any fake documents shown for verification. This is a very important step to protect patient data and prevent identity theft.
Understanding the concept of KYP
Knowing your Patient is key to resolving financial crime. As a healthcare provider, it is an obligation and compliance now to verify the identity of the patients. Some of the known eKYP procedures are:
- Onboarding remote patients,
- Converting existing patients who visit in person into online patients,
- Doing a thorough verification of patients’ KYC at every visit to ensure their authenticity,
- Preventing drug abuse and fraud,
- Maintaining the integrity of your practice and protecting your reputation.
Resolve issues in the healthcare sector with KYP:
KYP is a powerful tool that is shifting the healthcare sector’s mode of operation to a more transparent and easy-to-use platform. It has become a vital tool to help governments around the world prevent and stop criminal activities such as;
- Preventing prescription and insurance fraud
- Verifying the patients’ KYC and making sure that they meet the legal age limit before prescribing medicines to patients
- Protects and ensures that all sensitive medical information is only used by the actual patients for whom it is intended
All of the above measures ensure quality and efficiency of service in healthcare improvement.
Importance of Digital Onboarding and Identity Verification in the Health Care Sector
There has to be a phased implementation of identity verification and biometric authentication to verify patients’ legal age and other credentials. Some critical measures include:-
All online pharmacies verify the identity of the patients for whom they are dispensing medicine.
To prevent drug abuse by underage patients, there has to be video verification in the digital onboarding process to verify their age and an assessment of their capability and competency to use the purchased medicines responsibly. It becomes of paramount importance, especially for online pharmacies, as there is no face-to-face encounter with the Patient, and only an electronic form is filled up and emailed to the pharmacist.
Make sure that new patients are verified thoroughly before offering medical services. Curetting and simplifying patient intake can help a great deal in properly conducting KYP and reducing the potential for human error.
Hacking and using patient records to obtain treatment and medical services under false premises is a standard insurance fraud perpetrated by cyber terrorists. The incidence of this crime can be vastly reduced by implementing proper KYP procedures.
Protecting and ensuring patient records are stored securely is one of the critical functions of healthcare organizations. Stolen or compromised patient data could sully the reputation of your organization or healthcare facility.
KYP tools for healthcare
In India, ultrasound needs government identification. It is to ensure that sex identification and sex selection are not made based on the sex of the baby. The main reason to prevent this is to prevent female infanticide.
KYP is also done while onboarding clients at various hospitals. An electronic health record of the Patient is created not only to record the case history but also to satisfy the requirements of insurance companies for meeting medical claims.
The following KYP processes help ease the process of patient onboarding and create a permanent Electronic Health Record.
- Biometric Verification, where face match verification and face Trace ensure that the Patient is the same as what it claims
- Liveness Detection, especially for telehealth consultations, checks whether the Patient is an actual or a dummy.
- Government Database Check for checking Aadhaar card and Pan Card ensuring the Patient’s identity.
- Document Verification saves manual work time.
IDcentral Process of developing a successful KYP procedure for patients.
IDcentral’s online solutions, which consist of a comprehensive package of KYC verification, document verification, Video screening, face match, government database check, and biometric verification, all go a long way to minimize healthcare fraud and help in cybercrime prevention. Whether you are an online pharmacist or a telemedicine practitioner, IDcentral has optimal solutions to carry out KYP procedures, identity verification, and screening underage patients so that your patient data is secure and adequately verified.
Learn more about IDcentral’s AI based Digital Onboarding and Biometric Identity Verification Solution