The Prevention And Control Of Medical Identity Theft

When confidential patient information is disclosed without consent it is a violation of the HIPAA Title II Security Rule. This rule was enacted in response to private information being leaked to the news and emails containing privileged information were read by unauthorized people. Identity theft is a real concern so patient privacy should be taken seriously. This is a rule can easily be broken without the

In the health care business, there are certain standards and laws that have been put in place to protect our patients and their personal health information. When a health care facility fails to protect their patient’s confidential information, the US Government may get involved and facilities may be forced to pay huge sums of money in fines, and risk damaging their reputation.

When providers or patients submit false or misleading information intentionally to a health plan, this is fraud. Some examples of healthcare fraud and abuse include filing claims for services or medications not actually performed or obtained, billing for services for non-covered items using codes for billable services or items, altering medical records, waiving co-pays and deductibles, up coding and unbundling, using someone’s insurance card, billing Medicare patients at a higher fee than non-Medicare patients, and accepting kickbacks for referring patients, to name just a few. Fraud can be committed by hospitals, medical providers, laboratories, pharmacists, billing services, medical equipment suppliers, and even patients. Patients can protect themselves from healthcare fraud and abuse by knowing their healthcare benefits, reviewing the explanation of benefits, asking the doctor to explain the service that was given, report discrepancies, protect insurance cards and member identification numbers, beware of free services, report copayment and deductibles being waived, and never sign blank insurance forms.

Fraud and abuse encompasses the actions of fraud, abuse, and waste in the health care system (McWay, 2014). It is a nationwide problem that affects all of us and can be committed by anyone. Schemes can be committed by a single person or a by an institution or group. The National Health Care Anti-Fraud Association (NHCAA) estimates that

The significance of patient privacy and the security of confidential information are increasingly vital given the approval of electronic health records. Healthcare providers have recognized striking prices due to security threats and subsequent breaches. According to U.S. Department of Health and Human Services (2002), under the Privacy Rule healthcare establishments must establish protections that establish procedures and rules that guarantee least levels of privacy in relation to patient information. When violations are recognized, it is required that a compliant be created by the individual or unit experiencing the violation. In the complaint, the name of the person who participated in the violation, in addition to the nature of the violation, must be comprehensive. The filing of the complaint initiates an investigation by the Secretary of the U.S. Department of Health and Human Services under HIPAA values (U.S. Department of Health and Human Services, 2013). The establishment of a procedure related to privacy violations has resulted in many cases relating to electronic data breaches. Next is a consideration of two such cases to demonstrate the role of privacy in regards to HIPAA and electronic health database breaches.

The good news is that there are ways to prevent these breaches from happening altogether. The government has created laws to help fix these breaches, and to punish those who intentionally steal private information. These laws are HIPAA and HITECH. HIPAA created security for the exchange of medical information (US Dept of Health 2002). When someone goes to a hospital or doctor’s office and they are asked sign a document about whether or not they can release medical information to other doctors or hospitals, this is HIPAA in effect. The individual chooses whether or not they want their information to be sent anywhere else. This law makes the medical facilities accountable for protecting all medical information. HITECH was put into effect for

Research identity-theft cases from medical offices.Explain the case and prepare a one-page paper on prevention strategies based on the case found.

The security and privacy of personal health records has been a long standing concern of providers and patients alike. However, this concern has developed into a large scale lack of continuity for patient’s most private health information. Dr. Deborah Peel, a physician and Freudian psychoanalyst, is a long standing advocate for the improved rights and control of personal health information. She notes that the Health Insurance Portability and Accountability Act (HIPAA) does not protect health data, but creates commercializing of health information (Peel, 2014) and is no longer about patient care. In past years it was easier to maintain custody and control of hardcopy patient health records. The misconception is that this data is safely guarded

Fraud and waste of resources allocated for Medicare pose major risks to the program. Medicare is very vulnerable to a number of frauds majorly due to the fact that the program is hardly audited. Medicare scams occur in various ways that include phantom billing where healthcare providers demand money from Medicare for services not offered. The other form of fraud happens in the shape of patient billing where the patients collude with scammers to claim for kickbacks for false medical treatments. The last type of fraud is the upcoding scheme and unbundling, where bills are inflated by claiming that a patient needs more valuable services or procedures than the existing. The government has been sensitizing the general public on the need to avoid such frauds by not disclosing their Medicare card details to

Annually, America spends trillions of dollars on health care. To be more specific, roughly ten thousand U.S. dollars is used per person. However, health care fraud costs our nation about sixty-eight billion dollars every year. Being that, thousands of families are exploited and forced to undergo risky medical procedures. In addition, an individual's lawful insurance information and private medical record are used as false claims against them. As a result, it is worrisome seeing a family who could afford the means easily but still embezzles a member ID card that does not belong to them; while single mothers with several children are being rightful and properly paying for Medicaid or other programs while they have a low-income salary.

Last week it was reported that 500 patient records had been compromised. Our IT Security department has done an extensive audit and concluded that there are many issues with our security system regarding the protection of our patient’s privacy. Outlined below are some issues that were found and how they are going to be addressed going forward.

Security breaches of EMRs vary from someone without consent viewing the patient’s information, to a hacker using the information to steal one’s identity. According to Privacy Rights Clearing House, more than 260 million data breaches have occurred in the United States, including those of health related records. Approximately 12 percent of data breaches involve medical organizations (Gellman, 2012). According to Redspin, a provider of Health Insurance Portability and Accountability Act risk analysis and IT security assessment services, more than 6 million individual’s health records were compromised during a period from August 2009 and December 2010 (Author Unknown, 2010). A provision of the Health Information Technology for Economic and Clinical Health (HITECH) Act requires all breaches affecting 500 or more people to be reported to the Department of Health and Human Services. This reporting is to be accomplished within 60 days of discovery. The Redspin report covering the period above involved 225 breaches of protected health information. The amount of people with access to an individual’s health record creates concern with confidentiality. According to the Los Angeles

I agree, Kelsey. Thieves take personal information to create ID's. My mother was a victim of taking birth dates and social security numbers of 12 individuals ‘to seek medical attention, for her narcotic addiction. She would overhear the personal information and write it down to use at another hospital. However, my mother and I don't have a relationship, but I don't think she was ever charged. That is why it's important to monitor your personal information and never say anything where others can over hear.

You need to take measures to prevent medical identity theft. This type of theft is when someone pretends to be someone else in order to use their insurance or for other reasons. (Like they're wanted by the police.) Unfortunately, as with other identity crimes, medical theft is on the rise. But to protect yourself, you can take measures to prevent medical and other identity crimes. Here are a few common sense things you can do.

Privacy and confidentiality are basic rights in our society. Safeguarding those rights, with respect to an individual’s personal health information, is our ethical and legal obligation as health care providers. Doing so in today’s health care environment is increasingly challenging (OJIN, 2005).