Know Your Patient: Verifying Patient’s Medical Identity to Prevent Fraud


From 2009 to 2020, almost 3,705 data breaches occurred in the healthcare
industry and most of these breaches happened due to theft, loss, or exposure.
This is equivalent to 81.72% of the US population getting affected.

Cybercriminals affected the
medical records of
143 million patients in 2017 that far exceed the value of stolen
credit cards. Healthcare providers often leave patient’s medical records
exposed that are stolen easily by criminals. Although, given the tremendous
growth of identity theft – criminals find it easy to make themselves seem like
legitimate patients. This is the reason, health care providers need to properly
vet their patients to make sure their patients are who they claim to be.

Know Your Patient
correlates with the KYP requirements of financial industries that usually
involves carefully considering methods pertaining to identity verification and
due diligence. Therefore, it’s important for the medical facilities to verify
patient healthcare ID and comply with regulations such as HIPAA. Medical
centers can prevent heavy fines and penalties by meeting Know Your Patient
(KYP) requirements.

Moreover, the Healthcare
industry is fragmented into separate parties that deal with different data
requirements to provide patient care. Therefore, each party requires to know
the person’s real identity for treating all patients correctly. The medical
information is highly confidential and is shared only with the most relevant
healthcare providers. Because keeping up to date and accurate data is vital
that affects patient’s treatments and their recovery.

Consideration For Patient Identification

Nowadays, healthcare
centers vary in how they collect information to
patient identity
Moreover, countries around the globe use patient identifiers to assist with
patient identification while in the United States it’s prohibited to use UPI
due to privacy concerns.

As healthcare data
continues to grow, challenges posed with healthcare data can be minimized
through the accurate matching of data with the patient’s health. It would
ensure patient’s safety and security while making sure that all resources are
appropriately used.

The errors during the
patient identification have various implications on patient care, safety,
payment, and Know Your Patient regulations. However, with advancements in
technology, there is no solution that can provide a 100% match. But optimizing
the algorithm matching with an identity verification tool could provide an
enhancement in patient identification. Moreover, to improve the patient
eligibility verification, healthcare providers can adopt patient photos during
the registration and standardized processes to keep up-to-date patient
demographic data.

Therefore, it’s important
for the healthcare industry to practice different technological approaches or
practices to gain operational excellence. This would help the organization to
meet Know Your Patient regulations and avoid stolen patient IDs.

Protecting Yourself From Medical Identity Theft

It’s a widely known fact
that the medical cost is unrealistically high that can turn-out to be even more
expensive if it’s not covered by insurance. Therefore, this cost provides a
high incentive to criminals for committing medical identity theft. It usually
involves illegal access or use of a patient’s personal information for
obtaining medical treatment or goods.

However, as proven through
several years that there is no single way to keep your information secure, here
are few basic steps to avoid medical identity fraud.

Make sure
to go through all notices provided by health planners like doctors or

if your medical information gets stolen or lost – you can ask to get a new card
along with the health insurance identification number.

should avoid sharing your health care information with another person or a
company that is claiming to provide free products or services.

someone tries to initiate a conversation over the phone call or through an
email – never share your information unless or until you have confirmation that
the person on the other end isn’t a fraudster.

Make sure
to properly dispose of the documents, containing your personal information.

monitor unpaid bills in your credit because it might hurt your credit history.

once every year, make sure to check your medical records.

keeping few copies of the medical records as proof of information.

You would want to add
similar practices that might already be in use for avoiding various types of
identity theft. It involves using a unique password with your online medical

To digitize the initiatives
in the healthcare industry – more effective methods with
identity verification are required. Integrating a sophisticated solution would
help with a quick and seamless experience that can ease the onboarding of new
patients for changing insurance coverage. It would not only help healthcare
industries to improve patient experience but would also ensure compliance with
Know Your Patient (KYP) regulations. This way, industries can also avoid any
fraudulent activity.

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