The following is a guest article by Bala Kumar, Chief Product Officer at Jumio
The list of responsibilities for a CISO in healthcare is constantly growing. Today’s threat landscape requires them to plan for ransomware and malware attacks, protect against traditional vulnerabilities in legacy equipment, and mitigate the risk of internal threats.
With those competing priorities, fraud prevention does not always make its way to the top of the list of considerations, even when it should. According to the National Health Care Anti-Fraud Association, fraud costs the U.S. healthcare industry more than $50 billion each year.
When a patient’s identity is compromised, thieves can use this stolen data to file phony claims with insurance providers. Not only does this harm the patient, but the healthcare organizations themselves are then left to sort through the fraudulent claims and incur legal expenses.
Just as financial institutions have adopted the Know Your Customer (KYC) process to verify the identity of their clients and help prevent financial crime, healthcare organizations can implement Know Your Patient (KYP) processes to address the ongoing threat of insurance fraud.
Here is a breakdown of how KYP works and what makes it useful for healthcare providers in combating insurance fraud.
What Exactly is KYP?
Let’s start with KYC, which is a vital part of today’s regulatory environment that helps financial institutions verify client identities and prevent them from being used, either intentionally or unintentionally, in money laundering activities. By confirming identity at the beginning of the user journey, like when a customer first attempts to open a bank account, organizations can ensure that any malicious actors are kept out of their systems ahead of time.
The KYP process is essentially designed to function in the same manner, but on behalf of healthcare organizations. KYP is intended to help eliminate the risk of fraud on the front-end of the patient experience, primarily by instituting a more secure onboarding process for new patients and verifying that people are who they claim to be at the beginning of the relationship.
Given the degree to which medical institutions are being victimized by fraud, now is as good a time as ever for organizations across the industry to consider implementing a KYP program.
Getting with the Program
Developing an effective KYP program consists of a few key steps supplemented by an ongoing authentication process. It is important for organizations to remember that identity verification requires more than a set-and-forget approach as fraudsters will try to target providers through both new and existing accounts.
The first step in the process is to verify that a registrant’s government-issued ID is authentic and valid. When a patient goes online for their initial registration, they will be prompted to capture their ID (e.g., a driver’s license, passport, or other ID card) via their smartphone or computer’s webcam.
From there, the patient will be instructed to take a live selfie to ensure the person behind the ID is the actual person trying to open the account. The biometric template created during this step will come in handy for future authentication. Key identifiers and biometrics features can be cross-referenced to verify whether the photos are a match.
There are several red flags that may pop up when checking an ID. For example, minimum age requirements may impact a patient’s ability to open an account. Fraud detection analytics can also reveal any potential connections to fraudulent activity history associated with the registrant.
Depending on the results of these identity checks, the KYP program will then render a verdict for the organization to either approve or deny the new online account registry. If an ID matches with the identity verification results, registration is considered complete and an account will be active. Once an account has been approved, pharmacies and medical offices will be able to approve any future prescriptions and treatment requests by capturing a new selfie of the patient. Each time a selfie is taken, it will generate a new biometric template that can be compared automatically to the template captured at enrollment in order to authenticate the patient.
These steps are essential to safeguarding providers, protecting legitimate patients looking to access care and preserving organizational reputation.
A More Secure Future
The challenge that healthcare organizations face today when developing a fraud prevention plan is creating a seamless identity verification process while simultaneously reducing friction and deterring fraud. Unsophisticated identity verification programs or technologies that overdo it will block valid registrations. Those that underdo it will let fraudsters in.
Advanced KYP technology is built to walk this fine line by letting in legitimate patients and keeping out impersonators. Through the use of identity verification and authentication, organizations can easily verify their patients in a matter of seconds, comply with regulations, and better detect costly attempts at insurance fraud.
About Bala Kumar
Bala is responsible for Jumio’s product vision and strategy and is leading the execution of Jumio’s digital identity platform. A former TransUnion executive, he brings more than two decades of product innovation and leadership experience to Jumio.
