Addressing medical fraud and identity theft
Access to good healthcare is essential for a country to develop and prosper. However, medical fraud and identity theft are important concerns in healthcare and medical claim systems. Fraud due to, for example, unjustified claims being submitted by healthcare providers, might result in losses of hundreds of millions of dollars every year, thus increasing the overall cost of the health system. Medical identity theft, where health cards are borrowed from friends or relatives, is a concern for healthcare providers, patients as well as the health insurance organizations.
GenKey offers a complete, cost-effective, biometric-based solution to:
- minimize fraud caused by identity theft and unjustly submitted claims
- prevent medical mistakes due to medical identity theft
- simplify the vetting process and automate the claim process
- improve data integrity of the entire process
The solution brings these benefits for both public and private health initiatives, healthcare providers and insurance companies.
The solution includes:
- Biometric member registration to capture the biometrics and enroll the members.
- Large-scale biometric-based deduplication to obtain a duplicate-free member database. The deduplication performed by GenKey’s Automated Biometric Identification System (ABIS) ensures that one and the same person is not registered twice.
- Adjudication to ensure that all legitimate members will be included in the register. Adjudication enables manual review and validation of potential duplicate records detected by the biometric system (ABIS).
- Biometric member (patient) verification to ensure that the right person gets the right service.
- Biometric check on the medical claim to ensure that the member was present at the healthcare provider at the time that the claim was generated.
ClaimSync Medical Claim
GenKey ClaimSync is a biometric-based solution for handling and simplifying medical claims while minimizing related claim fraud. It is based on the following simple steps:
- Registration: Upon registration for healthcare services, patients get issued a membership card containing their biometric information. The card is made such that the biometric information and other card data (such as name and member number) are protected against tampering and abuse.
- Verification: While requesting service at a healthcare provider, firstly the patient is biometrically verified against his member card. This step prevents medical mistakes due to medical identity theft. During the biometric verification process, a proof-of-presence is generated in the form of a 6-digit number which is added to a claim. Since this number can only be generated for this specific claim when the patient is present, this second step prevents a healthcare provider from submitting claims for treatments that were never given.
- Claim processing: When the claims are processed at the health insurance organization, reimbursement of the claimed amount will take place only when the proof-of-presence verification process is successful.
GenKey ClaimSync is a cost-effective solution and is easy to integrate into existing systems of member registration and claim handling.