Expenditures in the United States on healthcare were nearly $1.9 trillion in 2004, more than two and a half times the $717 billion spent in 1990. In this high-value environment, huge amounts of sensitive personal, medical and financial information are transacted daily, creating numerous opportunities for fraudulent activity.
Under the U.S. Health Insurance Portability and Accountability Act (HIPAA), health insurers and health care providers must take steps to protect the privacy of patient-related information, such as medical and payment data. Despite the implementation of physical and procedural safeguards, the vast volume and range of documentation involved in the industry still leaves numerous gaps in protecting individuals and institutions from the risks of compromised printed materials.
Areas of Concern
Patient Identity and Private Information Protection
With the advent of HIPAA, the need to secure and protect confidential patient information in the healthcare industry became more than a professional obligation; it’s now a pressing legal mandate. The Privacy Rule creates national standards for protecting medical records and personal health information, putting intense pressure on healthcare environments such as hospitals and clinics to protect the integrity of all patient information. While this has been done increasingly well in the electronic data realm, myriad printed documents with personal and medical data are exposed to potential misuse.
Health Insurance Fraud
According to some industry experts, losses due to Medicare fraud alone may exceed $20 billion dollars. Additionally, between four and eight percent of healthcare claims are estimated to be fraudulent, costing the industry over $50 billion. This fraud is attributed to fictitious physician or institutional billing, false or inflated claims, and other types of improper actions. With the new prescription drug benefits recently signed into law as part of the Medicare reform act, the program can expect to see even more types and patterns of fraud and abuse.
Prescription Fraud
Prescription fraud is rampant throughout the country, with estimates placing the amount spent on fraudulent prescriptions at extremely high volumes, competing with the level of spending on illegal drugs. Fraud ranges from theft of prescription pads, altering or forging of prescriptions, ‘doctor shopping,’ counterfeiting of pads, and illegitimate online ordering of medications. Pharmacies may commit fraud by substituting generic medicines for name brands, short-counting pills, and falsifying billing. With a lack of comprehensive standards for protecting the prescription drug system, the various efforts are partially effective at best.
Outlook
An increasing pool of regulatory legislation and the ongoing movement to electronic management of healthcare industry information are enhancing the security of much of this information. However, healthcare continues to record much of its sensitive patient information in paper form, and leverages printed documents at key points in areas such as insurance claims, applications, prescriptions, etc. The industry must find ways to ensure that patient information and business profitability are not compromised by the fraudulent use or alteration of such information when it is in printed form. Healthcare businesses and institutions can achieve higher levels of security by leveraging foundational technologies that enable easy authentication and protection, and provide additional layers of security in its printed materials.
AuthentiGuard On-Demand Can Help
AuthentiGuard-On-Demand is a sophisticated print security technology that combines the benefits of copy and tamper protection with the ability to conceal sensitive data within printed documents. Utilizing standard desktop and commercial printers, the solution provides for the dynamic delivery of comprehensive protection to patient records to guard against HIPPA breakdowns, as well as costly and dangerous prescription and insurance fraud.