By: LYNNE JETER
Healthcare Providers Must Be in Compliance by May 1
In Jackson, Miss., the office manager of a physicians' practice quietly went on a spending spree. She had plastic surgery done, dined at the finest area restaurants, bought a hot tub and then an RV, and spent big bucks on other luxury items that eventually totaled $120,000.
Today, she's serving three years in federal prison, paying restitution, and faces three years of supervised release after completing her sentence.
...Identity fraud is the fastest-growing type of white-collar crime in America. Medical identity theft is the fastest-growing type of identity fraud, having mushroomed more than 400 percent in 2008.
Medical identity fraud typically takes place when a person's name and parts of their identity—insurance information, for example—are used to acquire medical goods or services without that person's consent, usually because the criminal needs treatment or is uninsured. This type of deception often results in erroneous entries being placed in existing medical records and may involve the creation of false medical records in the victim's name....
...Aimed at thwarting medical identity fraud, the new Red Flag Rule under HIPAA requires mandatory compliance by healthcare providers—which the FTC labels as creditors—to have an Identity Theft Prevention Program in place by May 1.
"The financial ramifications of your patient's information being lost or stolen could be devastating to even the most successful practices," said Asbell. "Did you know that a medical insurance card can sell on the black identity theft market for up to $500 each? Did you know that a patient's chart is worth $100,000 to an identity thief? It doesn't matter how the thieves get the info, your facility can still be held liable if you don't comply with the laws."
...Red Flags that definitely apply to healthcare:
- Documents provided for identification appear altered or forged.
- Photographs or a physical description on file are not consistent with the appearance of the patient.
- Other inconsistent information identifies the patient.
- Inconsistent signatures are on file.
- Patient forms or applications appear forged, altered, or destroyed and re-assembled.
Red Flags that may apply to healthcare:
- Statements sent to the patient or guarantor are returned as un-deliverable despite ongoing transactions on active records.
Red Flags that most likely do not apply to healthcare:
- A fraud alert is included with a consumer report.
- A consumer reporting agency provides notice of a credit freeze in response to a request for a consumer report, a notice of address discrepancy, and/or unusual credit activity.
- Financial institutions and creditors use challenge questions that the person opening the covered account cannot answer with readily available information.
- A request is made for new, additional or replacement cards or the addition of authorized users on the account shortly after a change of address request.
- A new revolving credit account is used in a manner commonly associated with known patterns of fraud patterns.
- The use of a covered account is inconsistent with established patterns of activity on the account.
- There is unexplained usage of a covered account that has been inactive for a reasonably lengthy period of time. (Full text at www.acadiana.medicalnewsinc.com)
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