Know Your Patient: 5 Ways to Prevent Fraud and Other Headaches in Health Care

Health care has fully entered the digital age, with most providers offering video visits and the ability to onboard new patients remotely. But along with this digital transformation is a dramatic rise in health care data breaches. According to the latest report in HIPAA Journal, 2021 saw more breaches than any other year since they started reporting in 2009.

In addition to violating the privacy of patients, these data breaches greatly increase the chances of medical fraud, as cybercriminals and people who purchase the stolen data on the dark web are empowered to more easily impersonate legitimate patients. This is why all sectors of health care need to properly vet and verify their patients to ensure that they are who they claim to be.

Whether you’re a medical practice or pharmacy, running a health care organization online means you need to solve these pain points:

  • Onboarding new patients remotely
  • Transitioning existing in-person patients to online
  • Verifying patient identity at every visit
  • Preventing drug abuse, health mules and fraud
  • Protecting your reputation

The Importance of KYP

Know Your Customer (KYC) is a vital process used by financial institutions to verify the identity of their clients and help prevent financial crime. Similarly, it’s essential for the health care industry to adopt Know Your Patient (KYP) processes to address the steep rise in prescription and insurance fraud, as well as to verify that patients are of legal age for specific medications and procedures.

Online identity proofing solutions help ensure that hospitals, pharmacies and laboratories provide sensitive medical information, test results and prescriptions to the actual patient — not to an imposter. Furthermore, the right solution can actually improve the quality and efficiency of patient service.

KYP Examples

Advances in digital identity proofing and biometric-based authentication technologies hold great promise for delivering health care in smarter, simpler and more cost-effective ways. Let’s take a look at some examples.

1. Identity Verification for Online Pharmacies

More and more regulations require online pharmacies to verify the identities of patients seeking prescriptions. This is important for preventing medical fraud and ensuring underage patients are handled properly as described below. But more importantly, identity verification is essential to make sure patients don’t end up with the wrong medications, which can be a fatal mistake.

2. Age Verification and Confidence Assessment

The Royal Pharmaceutical Society counsels that in the absence of any age restrictions on children picking up prescription medicines, it is up to the pharmacist to judge whether “the child is capable and competent to understand the importance of the medicines they are collecting” and that they are “confident the child will not misuse or tamper with the medicine.” But the online pharmacy replaces this face-to-face encounter with a less stringent process that involves completing an electronic form, which is then approved by the pharmacist. A sophisticated KYP solution can detect underage patients and route them to a video session that will enable the pharmacist to make a more informed decision.

3. Streamlining Patient Intake

Verifying new patients is still a manual and time-consuming process. Streamlining the intake process boosts efficiency by drastically cutting down on potential for human error, further reducing time spent on rejected insurance claims. Patient information can now be captured from an insurance card or ID document (e.g., driver’s license or passport), and the patient’s identity can be verified in a matter of moments, saving time for both patients and employees.

4. Preventing Insurance Fraud

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. A thief may use your name or health insurance ID to see a doctor, get prescription drugs, file claims with your insurance provider, or get other care. If the thief’s health information is mixed with yours, your treatment, insurance, payment records and credit history may be affected. An effective KYP solution helps health care organizations do their part to prevent insurance fraud.

5. Protecting Your Reputation

If patient data falls into the wrong hands, it can tarnish your organization’s reputation. Having the power to verify patient identity allows hospitals and other practices to confirm that any given record is accurate and up to date, and gives them the peace of mind to know that their patient data isn’t being used by malicious hackers or fraudsters. It’s critical to the health care industry’s success to have a standardized, streamlined flow of patient information — one that includes identity safeguards.

Developing a KYP Program

Here’s how health care organizations can address the above challenges when developing a Know Your Patient program:

Step 1: Capture an online patient’s government-issued ID (e.g., driver’s license, passport or ID card) via the user’s smartphone or computer’s webcam, followed by a live selfie (from which a biometric template is created) to ensure the person behind the ID is the actual person creating the online account.

Step 2: Ensure that the ID document is authentic and unaltered and that the patient pictured in the selfie matches the picture on the ID.

Step 3: Check the returned identity for minimum age requirements and potential fraudulent activity through fraud detection analytics to help minimize risk and loss.

Step 4: Depending on the results, approve or deny the new online account and attempted purchases, or optionally route the patient to a video verification session.

Ongoing Authentication: After an online account has been approved, medical offices and pharmacies can approve future online prescriptions and treatment requests by capturing a new selfie of the patient, generating a new biometric template and using online identity verification technology to automatically compare it to the template captured at enrollment to authenticate the patient.

These steps are essential to safeguarding your organization, protecting legitimate patients and preserving your well-deserved reputation.

Understanding ID and Identity Verification

Digital onboarding processes can provide a mix of techniques to verify patient identity. Some ping databases to see if an individual exists in the real world. Some use ID verification to check the authenticity of a user’s government-issued ID and to ensure it has not been digitally manipulated. ID verification provides a strong trust anchor for online businesses, but it fails to assure that the user holding the ID is in fact who they say they are.

Online identity verification takes the verification process one step further and involves both an ID scan and the capture of a corroborating selfie to ensure that the person holding the ID is the same person shown in the ID photo and that they are physically present during the transaction. In this way, identity verification serves many benefits to organizations seeking to build trust in their online channels. Here are the top five benefits:

1. Fraud Deterrence

The addition of a selfie requirement and liveness detection has a chilling effect on online fraud and account takeover. The simple act serves as a strong fraud deterrent for scammers, since they prefer not to share their own likeness with the company they’re looking to defraud. Based on Jumio’s benchmark analysis, the selfie requirement reduces fraud attempts by as much as 90%.

2. Simple and Familiar User Experience

Most consumers today are comfortable using biometric authentication, while 87% say they’ll be comfortable with these technologies in the near future, according to IBM. Thanks to the broad adoption and familiarity of facial recognition integrated within the most popular smartphones – think Apple Face ID and Samsung’s facial recognition feature – this trend is rapidly increasing.

3. Security Checks

With identity verification, we go one step beyond ID verification by conducting a variety of security checks to verify that the patient’s selfie matches the photo on the government-issued ID, and that the selfie is real.

4. Liveness Detection

Given the rise of spoofing (the act of using a photo, video or a different substitute in lieu of an actual selfie), Jumio employs state-of-the-art liveness detection to ensure that a new patient is physically present when creating their online account.

5. Higher Levels of Assurance

Online identity verification delivers a much higher level of identity assurance compared to traditional methods of identity verification such as knowledge-based verification, credit-bureau pings and database solutions that are no longer reliable/secure thanks to large-scale data breaches, the dark web and other sophisticated hacking techniques (e.g., SIM swap fraud, man-in-the-middle attacks).

The challenge that health care organizations face is to create a seamless identity verification process while simultaneously reducing friction and deterring fraud. Jumio’s online identity verification and authentication can help you easily verify your patients online in seconds, improve conversion rates, comply with AML and KYC regulations and better detect fraud.

Next Steps

Jumio has helped many health care organizations implement KYP programs that provide the highest assurance without sacrificing user experience. We would love to discuss your specific needs and how Jumio can help you safeguard your organization. Just fill out this form, and a specialist will be in touch with you shortly.


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