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How Know Your Patient processes help fight healthcare fraud

Dean Nicolls, Vice President of Global Marketing, Jumio, examines how How Know Your Patient processes help fight healthcare fraud

Dean Nicolls, Vice President of Global Marketing, Jumio
|Sep 9|magazine7 min read

Healthcare data breaches have impacted more than 175 million medical records over the last decade — that’s the equivalent of affecting more than half of the U.S. population. 

What’s not commonly understood is that medical records command an exceedingly high value on the dark web because there is far more personal information attached to health records than any other electronic database.

Given the scope of recent data breaches in this space, and the growth of the dark web and identity theft, cybercriminals are now more empowered than ever to impersonate legitimate patients. Therefore, it is critical that all healthcare sectors properly vet and verify their patients to ensure that they are who they claim to be.

The emergence of KYP

Know Your Customer (KYC) has formed a vital part of today’s financial regulatory environment and is the basis of verifying the identity of clients to prevent banks from being used by criminal elements for money laundering activities.

Now is the time for the healthcare industry to adopt a similar standard – something we call Know Your Patient (KYP).

The growing need for online identity verification

There are a number of clear reasons for online identity verification. For example, there are growing regulations that require online pharmacies to verify the identities of patients seeking prescriptions. 

KYP can also streamline the patient intake process, automating data capture and drastically reducing the potential for human error. 

Health insurance fraud is yet another area for consideration. When a patient’s identity and privacy are compromised, not only do they suffer financial fallout, but the industry has to deal with fraudulent claims and any related legal fees. 

Underpinning all of these use cases is reputation management. If patient data falls into the wrong hands, it can tarnish that organization’s reputation instantly. 

It’s therefore vital that healthcare organizations get the verification process right. Advances in digital identity proofing and biometric-based authentication technologies hold great promise that healthcare can be delivered in smarter, simpler and more cost-effective ways.

KYP in practice

So how would a KYP process work? Patients creating a new account are asked to take a photo of their government-issued ID (e.g., driver’s license) using their smartphone or computer, followed by a live selfie (in which a 3D face map is created) to ensure that the ID is authentic and that the person pictured in the selfie matches the picture on the ID. 

Hospitals, offices, clinics and pharmacies could then check the returned identity for minimum age requirements and potential fraudulent activity through fraud detection analytics to help minimize risk and loss.

After an online account has been approved, providers could approve future online prescriptions and treatment requests by capturing a new 3D face map of the patient and using online identity verification technology to automatically compare it to the 3D face map captured at enrollment.

Now is the time for health care organizations to adopt a rigorous KYP process. These steps are essential to safeguarding their business and reputation while protecting legitimate patients. 

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