Know Your Patient: Verify Patient Identity for Fraud Prevention


The medical sector is vast and complicated, and it handles highly sensitive details. In order to check a patient’s identity for regulatory standards (such as HIPAA), help stop health care identity theft, and satisfy other Know Your Patient demands, it is critical to acquire and process identity data effectively.

Know Your Patient is a wide-ranging term that refers to the Know Your Customer needs in the finance industry, which includes a thorough verification process and due diligence methods. While there are strong similarities, such as strict rules and regulations, and the threat of theft, the wellness sector’s customer service habitat is inherently more complicated. To provide services and care to patients, the medical system depends on various groups, each with distinct information criteria. A physician, drugstore, research lab, expert, hospital, nursing agency, governmental agency, insurer, and other professionals may be required for a single patient with a single illness.

To ensure that they are handling the appropriate people, each group in the health care trip must know the patient’s identity. They must also ensure that health documentation is kept anonymous and confidential and that it is discussed only with the verified person and adequate health care professionals. Maintaining accurate records that are linked to the accurate identity is essential to enhancing health treatment and therapy.

Patient Verification for HIPAA

For instance, HITECH, HIPAA, and CLIA are state, governmental, and sector-specific compliance rules and restrictions for validating patient identity in the United States. 

HIPAA formulated a series of federal guidelines for managing patient information. HIPAA is created to allow for the efficient creation and streamlining of digital records while also ensuring that the documents’ integrity and use are protected.

Any business that handles preserved health information (PHI) must ensure that it has adequate privacy safeguards in place to defend patient records of all kinds. Such as raw data, emails, lab tests, and supporting documents. Security precautions, the use of policies, user access, book-keeping provisions, and communication protocols are all examples of these safeguards. 

For the PHI disclaimer, there is a standard verification criterion.

If the authenticity or authority of an individual seeking preserved health data is unknown to the doctors or physicians. With the exception of revelations under section sign 164.510. Confirm the identity of an individual requesting healthcare information. And the jurisdiction of any such individual to have full rights to protected healthcare data under this subclause.

Smart healthcare professionals and organizations will safeguard their own and their clients’ details and preferences in this age of high-profile data thefts and privacy civil suits. 

Identifying Patients to Prevent Medical Identity Theft

The price of adequate medical care can be quite high, particularly when it is uninsured. Medical identity fraud. Which is defined as the unauthorized access and usage of an individual’s personally identifiable information (PII). To acquire medical care, offerings, or products, has a substantial financial incentive as a result of this expense.

In accordance with a U.S study in 2017. Over 300 medical sector data infringements were reported in the United States. Potentially endangering 171 million individual patient files. Despite the fact that routine ID thefts make the headlines. So the estimated value to the victim is $55. When you make a comparison to the ordinary victim expense of $13,500 for medical Identity thefts. The magnitude of the crime becomes clear. Due to prescribed medication activity. Victims may lose their health insurance. Have their credit records harmed, and even face prison time. Patient age verification should be a must in order to reduce misuse of prescriptions.

Reducing Inaccurate Medical Information

The most serious problem is when incorrect and possibly life-endangering information is entered into a patient’s medical record. Health files are hard to tinker with. Because they are intended to be a thorough and long-lasting record of an individual’s medical care history. According to HIPAA “the right to request an amendment does not apply to medical information not created by the provider or insurer. Currently maintaining or using the information.” As a result, incorrect data inputted by a third person may never be changed.

Assuring precise identity at the outset of a provider would safeguard patients and reduce losses due to false allegations and false billing.

Improving Patient Identity Process Across the Industry

There are numerous applications for accurate patient recognition throughout the medical care process. As virtual health-care proposals are becoming more advanced and widespread. Efficient digital identity verification becomes more important. Smooth and convenient identity procedures are a way to refine patient satisfaction. Help make sure compliance, and prevent frauds and scams used in everything from telehealth discussions to online drug stores. Onboarding new users to modifying health insurance.

Leave a Reply

Your email address will not be published. Required fields are marked *