One of the worst fears of U.S. healthcare providers is data beaches because of the potential for medical identity theft. This is not surprising at all, since there are many hospitals and health systems that unfortunately do not have access to the best cybersecurity tools.
However, they still need to use the resources available to prevent data breaches, and if they are unsuccessful, they face the consequences - litigation costs, unwanted attention, medical identity theft, loss of goodwill, and more. Data breaches are quite crucial - there’s even a HIPAA Breach Notification Rule that outlines what healthcare providers must do when they face one. While data breaches might not be avoidable due to several issues such as budget constraints, preventing medical identity theft is what caregivers must focus on.
Let us take a brief look at how data breaches and medical identity theft are related, the impact of the latter, and the benefits of preventing fraudulent cases.
Medical identity theft occurs due to a variety of reasons, one of the more common ones being due to data breaches. See, patient identification in the U.S. is already a significant concern, and fraudsters take that advantage.
For instance, if a healthcare provider suffers from a data breach, the information is already available to the hacker(s). Most of them sell it on the black market for hefty prices - up to $1000 per EHR. Many individuals buy the information, and while their motivations might vary, they end up committing medical identity theft.
Since patient identification is shaky at most healthcare facilities, these fraudsters are not red flagged in real-time. This leads to the fraudsters getting away with availing healthcare services, buying medical devices, and making fraudulent claims. Moreover, these cases are detected a long time after the crimes were committed, and in many cases, are undetected.
If caregivers could identify patients accurately, then preventing medical identity theft would have been possible for the caregivers in real-time. Unfortunately, not every healthcare provider chooses to opt for a solution that can red-flag fraudsters whenever they pose as the patients, such as patient identification platforms.
Coming to patients, identity theft is even worse for them - let us explore how.
As mentioned,a few times, patient identification is in a problematic state. Not only does it lead to patient misidentification cases, patient safety incidents, patient mix-ups, and preventable medical errors, but it is also one of the leading causes why fraudsters committing medical identity theft are not caught red-handed. However, due to this, many of these cases remain undetected, and even if detected, can be extremely costly.
If a patient becomes a victim of medical identity theft and all the concerned parties (healthcare providers, payers, patients themselves) are unaware of it, then it leads to patient safety issues down the line. For instance, when a hospital fails in preventing medical identity theft, the fraudster will be fraudulently availing treatment, medical devices, or other services. When they go for treatment, their preferences will be recorded in the EHR of the victim. This tampers patient data integrity as the victim might have quite different healthcare requirements than the fraudster. When the victim needs to avail healthcare services subsequently, they will face detrimental healthcare outcomes as the treatment is based on wrong information.
If medical identity theft is detected, even then, it is a long, strenuous, and costly process to rectify the damages done by the fraudsters for both the hospital and the patient. Many patients even must pay for the bills generated by the fraudsters, and in other cases, hospitals are sued by the victims. At the end of all of this, hospitals lose goodwill, a significant amount of money, and trust from their patients.
As can be understood, medical identity theft must be prevented at all costs - let uslook at some of the benefits of doing so.
Medical identity theft leads to patient data corruption as the EHRs become unusable afterward. If a hospital successfully prevents fraudsters, then they can also protect the victims’ information from being tampered with.
Quite naturally, hampered patient information leads to dangerous healthcare outcomes if not detected or addressed beforehand. By preventing medical identity theft, healthcare providers ensure that the patients are receiving accurate treatment, especially if they are accurately identifying their patients.
Eliminating medical identity theft means that there would be no lawsuits, litigation costs, revenue losses, or administrative costs related to it. Moreover, unwanted attention and loss of goodwill can also be avoided if a provider chooses to prevent such cases.
While caregivers are going all-in to prevent data breaches, in many cases, they are not preventable. But that does not mean that they cannot cut their losses - by stopping medical identity theft, caregivers can potentially save millions of dollars.