Fraud is on the rise in every industry and the lengths that some people will go to make money by “gaming” the system is both fascinating and alarming. Look for some of these stories in this regular feature designed to inform you of the latest fraud trends and provide practice tips to safeguard your business from unwelcome intruders.
Steps to Fraud- Proof Your Professional Practice
Fraud is an increasingly lucrative “ business” that weaves its web of deception through corporations, religious and educational institutions, and the provision of health care. The recent data breaches a la Target and Sony are just some of the more highly publicized examples of the breadth of this problem for businesses and their customers.
But did you know that the healthcare industry tops the charts of data breaches and fraud costs? In fact, The Economist (31 May, 2014) suggests that healthcare fraud in this country contributes to $272 billion dollars in incremental costs to the system.
Health records are like gold to fraudsters because they often contain financial information, insurance numbers and personal data that can be used to obtain drugs or other benefits. Converting this information in order to submit false healthcare claims has been a regular practice for some scammers.
As government and private insurers have stepped up their fraud detection models, medical providers likewise need to review their policies and step up their own monitoring to protect their practice from potential data breaches and fraud claims.
Have you considered whether your business is at risk for a data breach? Are you taking steps to “fraud- proof” your health care practice? Consider the following:
1. Perform a “Check- up.” Every practice needs one. Conduct a random review of your patient files to ensure that all information is appropriately filed and that the files are complete. Have your patients completed intake forms? Is there proper documentation of an accident or injury? How is the health information protected from improper disclosure?
2. Review Protocols. When was the last time you reviewed your policies? Have they been updated to comport with new HIPAA standards? Do you understand what the standards mean for you and your employees?
3. Billing. Make sure that your billing is done correctly and that those who have been entrusted to perform this function are on top of things. Have there been trends in collection? Have insurers rejected claims? Find out why.
4. Employees. Do not assume that your employees are aware of the dire consequences associated with the improper disclosure of health care information. Educate them and set a high bar for security of this information.
Stay tuned for more fraud stories and ways that you can prevent it from damaging your business.