WC Fraud does not have to be a “cost of doing business” even in Disneyland®!
Comment: Smart cards, particularly Smart cards that use biometric identification can be a cost-effective and easily implemented solution to the WC fraud problem of charlatans billing for medical care that wasn’t provided. Smart cards are also being used in the rapidly developing arena of identity management. Identity management’s goal is to universally and uniquely identify an individual. It becomes most important when one is identifying an individual within a system as a means to control their access to resources or establishing their rights or limitations within the system. Such is the case with employers, injured workers and medical providers in the WC system.
The incidence of people stealing someone’s identity to access either public or private health coverage is growing across the country. Apart from the financial cost to the system, once someone has obtained services using someone else’s identity, future medical care can be compromised. If the thief had a medical condition, such as diabetes, which was identified during care for an accidental injury, the actual person’s records would forever indicate that diagnosis of diabetes. This may deleteriously affect future care, leading to a potential disaster for an innocent worker who wouldn’t know of the diagnosis. What if the test results or physical findings are those of someone else, but doctors rush to rely on them when you have a medical emergency?
Given the increasing prevalence of identity theft in the medical area, what can Americans do to protect their information? Well, the most obvious ways to protect ourselves would be to take better care of insurance cards and shred/destroy all medical data before disposing of health-related records. We can also check credit reports frequently to ensure that no collections activity has been taken against us by medical clinics, etc. Please remember many injured workers hire lawyers when they are the subject of collection actions, leading to unnecessary WC litigation.
Beyond these obvious courses of action, however, it is a bit unclear what can be done to stop medical identity theft, since most of us are not even privy to our health records, which are often scattered all over a number of healthcare facilities. Given the fact that many of these records are not even stored in a centralized database to date, it seems highly unlikely that we are going to be able to start monitoring our health records in the near future. Privacy experts need to start grappling with these issues now before they can become a more significant problem down the road.
Current efforts to combat this medical identity theft are limited. Oftentimes, medical providers ask for a photo-id to further verify identity. However, these methods are unquestionably inadequate. A biometric identity card ensures the person presenting for services is who they say they are. It also better guarantees the sanctity of the related medical chart.
In the WC environment, employers and insurers often use a fairly consistent panel of medical providers. As such, a biometric identity system can be very effective in ensuring only authorized persons seek and receive care. Similarly, positive identity authentication makes it more difficult for providers to claim services were rendered when they were not.
The SHAPE Card® from Secure Services Corporation provides biometric identity authentication that is affordable and easily implemented. This is especially true in situations where a “panel” of providers is typically used. Added investigation would then be required only for new or non-participating medical providers.
This article was written, in part, by Pamela D. Mitroff, MBA, the Director of Public Relations and Communications for Secure Services Corporation (SSC) in Downers Grove, IL. SSC is a leader in identity management solutions, including a line of healthcare technology solutions built around their SHAPE™ environment. Their product line includes the SHAPE Card™, identity management through a biometric match-on-card, providing secure identification and authentication as well as the recently launched direct-to-consumer personal health record. More information is available at www.secureservicescorp.com. You may contact Ms. Mitrolff via email to pmitroff@secureservicescorp.com.
