Know Your Patient – Authenticating Patient Identity for Prevention of Fraud

Last updated on August 30th, 2023 at 02:59 pm

The healthcare sector is huge and intricate, and it authorizes with highly confidential data. This is why it is vital to accurately gather and deal with identity data in order to identify patients for regulatory authorities such as HIPAA, reduce identity theft, and comply with Know Your Patient laws.

Know Your Patient is a catching term that relates to monetary institutions’ KYC laws, which includes accurate identity authentication and due diligence processes. Therefore there are apparent parallels, such as stringent regulations laws and the risk of scams, the health sector has a significantly more complicated service delivery landscape. Know Your Patient depends on several parties, each with various data requirements, to give care to a patient.

Each body of the health sector journey requires to know the medication identifier to ensure they are treating the accurate patient. And, as health data is so secret and personal, they are required to ensure that the data is kept private and shared only with the legitimate patient and relevant health care providers. Keeping the accurate records associated with the correct identity is vital to efficient health treatment and recovery

Use Case # 1- the authenticating identity of a patient for HIPAA

The HIPAA built a set of national laws for dealing with patient information. Health Insurance Portability and Accountability Act is formed to enable the effective formulation and flow of electronic documents while keeping proper controls over the cohesion and use of those documents.

Any business that deals with PHI requires that they have proper protections in place to shield patient information of all sorts including raw information, emails, test results, and reports. These protections involve safety measures,  regulation policies, access controls, record-keeping laws, and communication laws.

There are standard authentication requirements for any protected health information declaration.

In section:

Rather than with regard to acknowledgments under § 165.430, authenticate the identity of a patient requesting PHI and the authority of any such individual to hold access to PHI  under this subcategory, if the identity of any such regulation of such patient is not identified to the covered company;

There are various situations stated, but see that “for most revelations, authenticating the authority for the application implies taking logical steps to authenticate that the request is valid under his authority.” In this period of extensive data breaches and companies will guard there, and their patients’, data and interests.

Use case #2 — limiting medical identity fraud

The amount of proper health care is probably expensive, particularly if not included in insurance. This amount creates a vital influence on medical identity theft; the illegitimate authorization and use of a patient’s PII to acquire medical surgery, medicines, and services.

As stated by the U.S. study in 2019 there were over 350 medical and healthcare data breaches, possibly revealing 171 million personal medical reports. Therefore, legitimate identity document theft usually makes the news, the average cost to an innocent is $50. Relate that to an average sufferer cost of $13,500 for medical identity document theft and the range of the crime becomes more prevalent. Innocents face the potential loss of protection security, loss of their credit records, and fraudster charges due to prescription drug activity.

Use case #3 — decreasing incorrect medical data

Possibly, the biggest uncertain issue is wrong and likely life-modification data being put in someone’s medical data. As medical data are intended as a comprehensive and robust account of a patient’s health history, they are very hard to alter. Under the Health Insurance Portability and Accountability Act, “the equity to request clause does not apply to medical data not created by the provider or insurer presently using or sustaining the data.” Thus, wrong information entered by a third party sometimes does not get changed.

Making sure of the correct identity at the start of service would assist in guarding patients and assist in combating the losses due to fraudulent activities and mistreating.

Increasing Know Your Patient across the industry

There are various methods for proper Know Your Patient along with the health care venture. As online health care actions become more intelligent and apparent, there’s direr to conduct efficient online IDV. From telemedicine visits to the digital pharmacy, onboarding current patients to altering insurance coverage, fast and smooth identity procedures are a technique to enhance the patient experience, assist make sure compliance and reduce fraudulent activities.