The digitization of healthcare products and services has made customer service more convenient and processes more efficient. However, the vulnerabilities of the online environment have created cybersecurity challenges.
In response to these virtual threats, healthcare organizations have sought technological solutions to ensure their operations' and patient data's security and reliability.
In this article, you will learn about the most common types of fraud affecting healthcare institutions and how biometrics can help combat these scams.
Healthcare Fraud
Because of the highly sensitive nature of the data involved, healthcare, whether remote or not, requires the adoption of essential security features that ensure the privacy of medical information and protect it from fraudsters.
Both remote and physical environments are, therefore, vulnerable to fraud. It is estimated that in 2022, the complementary healthcare market accumulated between 30 and 34 billion Brazilian reais in losses due to fraud and waste.
In addition to the civil and criminal consequences, fraud also impacts the provision of services, which becomes more expensive and less efficient due to the suppression of unduly paid amounts.
So, shall we look at the sector's main frauds?
Types of Healthcare Fraud
Fraud occurs for many reasons. Whether in the public or private sector, fraudsters use increasingly sophisticated scams that can cause significant harm. Read on to learn about the most common types of fraud reported in recent years.
Fraud in the Supplementary Health Sector
In June 2023, according to the National Supplementary Health Agency (ANS), 50.8 million people had access to a health plan, the highest number since 2014.
Given the increase in beneficiaries, supplementary health has become one of the favorite targets of fraudsters.
According to the Institute for Supplementary Health Studies (IESS), there has been an 884% increase in fraud cases reported about health services in the last four years. As a result, the National Federation of Supplementary Health (FenaSaúde) has launched a campaign called Saúde sem Fraude (Health without Fraud) to share information and warn people about scams.
The main health scams, according to the campaign booklet, are:
- Shared login and password: some scammers ask for a beneficiary's login and password, claiming they can help or need to access it for some adjustment when the real intent is to gain ownership of a third party's personal information for fraudulent activities.
Scams include exchanging beneficiary information, creating fake digital accounts, and requesting reimbursement for tests and procedures that were not performed.
- Health Card Lending: the digital health card remains a legitimate means of patient identification. Because it is a physical document, it is easily borrowed or stolen by someone who can misuse its benefits and use a beneficiary's personal information for other illegal purposes.
Fraud in public health
Public health also suffers from fraud, which affects how resources are managed, and free medical care is provided. The lack of transparency laws in the health sector is a significant cause of fraud and impunity, especially at the local level.
The most common frauds in public health care are:
- Falsification of the quantity or quality of materials: the health care institution declares a higher or inappropriate number of materials used, for example, using resources of better quality than those used.
This can happen with hospital supplies or the distribution of drugs.
- Phantom patients and employees: this occurs when the health facility claims that there are phantom users or employees to obtain funds intended for patient care or the salary of the service provider.
How biometrics can prevent healthcare fraud
Fraud usually involves the theft of patients' personal information. For fraud to occur, personal information must be provided by the recipient.
Therefore, the security of patient data should be a priority for organizations. According to a Doctoralia survey, 44% of clinics and hospitals surveyed intend to implement task automation by 2024, and 27% intend to invest in interoperability to enable integration and communication between different systems.
To this end, biometric technology is proving to be a solution beyond security. As a technology directly linked to physical characteristics, biometrics allows access to physical and virtual healthcare services to be linked only to the holder, preventing identity fraud.
To implement the solution, it is necessary to use Application Programming Interfaces (APIs) that allow information to flow between systems securely, quickly, and cost-effectively. In this way, it is possible to optimize the bureaucratic processes of hospitals, clinics, and laboratories, increase patient protection, reduce fraud in healthcare services, and support online consultations.
Other benefits of using biometric APIs include:
- Intelligent control of patient immunization and medical history.
- Ensure only authorized individuals can access exams, procedures, and medication records.
- Control restricted access to medical facilities.
- Validate identity-based on facial recognition and fingerprints.
- Prevent medical errors.
- Easily manage and store information.
- Ensure confidentiality and security of patient data and medical history.
Data security for fraud-free healthcare
In this article, you have learned more about the most common types of healthcare fraud and their detrimental effects on patients and healthcare organizations. You have also learned about the key issues facing the public and private sectors.
Biometric technologies are strong allies in overcoming security requirements and optimizing the management of healthcare resources and services.
BioPass ID offers biometric APIs that are already documented and ready to use. To learn more, contact one of our experts.
