PATIENT IDENTITY RESOLUTION FOR SMARTER HEALTHCARE Matt Kalina

2,000,000+ Patients are impacted by medical identity theft Over Half a Million more from 2013

68 BILLION DOLLARS Over 10 BILLION more from 2013

DUPLICATES 10.4% of records are problematic duplicates 10-12% of Records in a hospital are duplicates

BROKEN TRUST 56% of patients lose trust in their healthcare providers as a result of medical identity theft 56% of patients lose trust in their Healthcare Provider

REASONS FOR MEDICAL IDENTITY THEFT • Move to Electronic Health Records • Minimal set protocols to protect patients If your credit card is stolen, it may take a few minutes on the phone with the bank to reverse the fraudulent charges. But if your identity is stolen and used for medical treatment, it could take a year or longer to undo the damage. Victims may also get dropped by their insurance provider and end up paying the imposter’s bills just to make the problem go away, potentially to the tune of $100,000 or more. How big of a problem is it?

MAIN ISSUES OF MEDICAL FRAUD PATIENTS: Lack Awareness Costly Life Threatening HOSPITALS: Costly Hurt Reputation Time & Energy to Fix Brief synopsis and will dive into each later in the presentation. Let’s go through a few examples of real world Medical Fraud that has happened.

CURRENT PRACTICES TO PREVENT FRAUD PHOTO ID DoB First Name Last Name Address SSN HIPAA Protected Health Info (PHI) Security & Privacy RED FLAGS RULE Credit Card Info SSN/Employee Insurance Claim Background Checks Review Soft Characteristics of current practices Behind the scenes protocols put in place with HIPAA and the new Red Flags Rule in 2010. So with many protective protocols and procedures in place to protect from Fraud HOW is this happening still and why is it a growing trend?

WHY CURRENT PRACTICES DON’T WORK Not positively identifying the patients at the point of registration Patients are faking who they say they are and getting away with it never to be heard from again leaving chaos behind. So what is the New Age way to prevent Medical Fraud from occurring?

HOW DID THE MEDICAL IDENTITY THEFT HAPPEN? Review the first 5 reasons Family Members taking info without knowledge – extremely easy to do and the already know all the information about the patient Shared info willingly with friends – harder to eliminate when patients know but if set protocols were set to catch this from happening they wouldn’t be able to share Don’t know – most likely it was stolen without their knowledge by friends, family, or thieves online Mistake online – thieves are getting smarter (Personal story about me in Charlevoix) Data Breach – more and more common with cyber attacks and EHRs as you can see by the graph

24% A FAMILY MEMBER TOOK PERSONAL IDENTIFICATION OR MEDICAL CREDENTIALS WITHOUT MY CONSENT

23% I SHARED MY PERSONAL IDENTIFICATION OR MEDICAL CREDENTIALS WITH SOMEONE I KNOW

15% DON’T KNOW

12% BY MISTAKE I GAVE MY PERSONAL INFORMATION TO A FAKE EMAIL OR SPOOFED WEBSITE

10% MY HEALTHCARE PROVIDER OR INSURER HAD A DATA BREACH

WHY WAS YOUR MEDICAL IDENTITY STOLEN? Let’s take a step back and see why Medical Identity Fraud is occuring in the first place. Review the 1st three main reasons Why medical ID is stolen in the first place No Benefits themselves Drug Abuse

59% TO OBTAIN HEALTHCARE SERVICES & TREATMENT Let’s take a step back and see why Medical Identity Fraud is occuring in the first place. Review the 1st three main reasons Why medical ID is stolen in the first place No Benefits themselves Drug Abuse

56% TO OBTAIN PRESCRIPTION PHARMACEUTICALS Let’s take a step back and see why Medical Identity Fraud is occuring in the first place. Review the 1st three main reasons Why medical ID is stolen in the first place No Benefits themselves Drug Abuse

7 BEST PRACTICES TO PREVENT MEDICAL IDENTITY THEFT

1 ALWAYS ASK FOR TWO PIECES OF IDENTIFICATION AT REGISTRATION.

2 LOOK FOR INCONSISTENCIES IN THE PATIENT RECORD.

3 WHEN IN DOUBT, NOTIFY MEDICAL RECORDS AND CREATE A TEMPORARY JON/JANE DOE RECORD.

4 BUILD AWARENESS OF MEDICAL IDENTITY THEFT AS A QUALITY-OF-CARE ISSUE.

5 DON’T USE PATIENTS’ SOCIAL SECURITY NUMBER FOR IDENTIFICATION PURPOSES. Soft Identifier – you need a unique identifier or hard identifier to make sure the patient is exactly who they say they are

6 USE FRAUD DETECTION SOFTWARE TO PREVENT AND MONITOR SUSPICIOUS ACTIVITY.

NEW TREND TOWARDS BIOMETRICS New trend towards Biometrics. With a unique identifier such as Iris Scanning, Palm Scanning and fingerprint technology it will be impossible for anyone to commit fraud again even family members. This also will help deter Fraud from occurring in the first place since you cannot fake a fingerprint or palm scan. This Prevents fraud from happening and protects the patient information so no one else can use their medical benefits.

7 THINGS TO KEEP IN MIND WHEN RESEARCHING BIOMETRICS

1 PATIENT AND STAFF ACCEPTANCE.

2 EASE OF USE BY REGISTRATION STAFF.

3 RELIABILITY OF BIOMETRIC HARDWARE.

4 HIPAA COMPLIANCE

5 ACCURACY OF BIOMETRIC MATCHES

6 COMMERCIAL AVAILABILITY AND COST OF THE HARDWARE/SOFTWARE PACKAGE

7 ABILITY TO INSTANTLY VERIFY AGAINST MULTIPLE DATABASES

Review Map of Ohio and why the 2 counties went down

CONCLUSION Fraud is a growing issue Effects patients and hospitals negatively Solutions to help prevent and restore Thank everyone for listening Dismiss to lunch

44k patients die every year due to Medical Errors which are directly cooralated to Medical Identity Fraud and duplicate Medical records. Here’s an example of someone thankfully catching the medical error, otherwise it could have killed him.