Facts Medicaid Providers Resources
These facts Medicaid providers resources provides information about preventing medical identity theft.
Facts Medicaid Providers Resources for Preventing Medical Identity Theft
These facts Medicaid providers resources provides information about preventing medical identity theft. It is important for providers to protect medical identities, as it can have grave consequences on victims, and results in misuse of government funds. Medical identity theft is increasing dramatically, and Medicaid providers and patients are vulnerable. The theft involves appropriating or misusing provider’s or patient’s unique identifying information, with the intention of obtaining or billing for fraudulent medical services or goods.
Medical Identity Theft Schemes
Facts Medicaid providers resources points out that there are mainly two ways for billing fraudulent claims with the acquired medical identities that are stolen.
1) The criminal uses medical identifiers of providers, so that it seems that the providers have referred patients or ordered additional health services such as DME (Durable Medical Equipment), home health service, or diagnostic testing.
2) The criminal uses the medical identifiers of providers to make it seem that physician/s have provided services and billed for them directly.
Once medical identities are stolen, there are many ways of misusing them apart from making money. Fact about Medicare Advantage Plan is that it can also be misused with stolen medical identities.
Recognizing the Theft of Medical Identities
It is not easy to recognize the theft of provider or patient medical identity, as it could take months or even years for any signs to surface. A provider may become first aware of the identity theft, when he could receive overpayment notice from some health insurance company, which demands immediate repayment. Alternatively, it could even be a notice from the IRS saying that income was earned for services rendered but there was no mention of it in the tax statement. Recognizing the theft of medical identity is immediately followed by facing difficult financial consequences, and it could affect the reputation and practice of the provider.
Strategies for Minimizing Risk of Medical Identity Theft
Facts Medicaid providers resources provides some effective strategies for mitigating risks of medical identity thefts.
Actively Managing Information of Enrollment with Payers: Providers should have a system in place that will update payers about any enrollment changes, particularly when they open, close, or switch their practice locations. The reimbursement information available from the bank should be kept current, which will enable payers to alert the provider when there are additional billings that have taken place without provider’s knowledge.
Monitoring Compliance and Billing Processes: Providers can improve their program integrity by implementing sound and effective procedures and policies. The HHS-OIG has designed certain guidelines for improving business practices of providers, which can be very helpful. Having a sound billing process is extremely important, and providers should be aware of the billings taking place in their names, and should pay attention to establishments that were assigned billing privileges.
Control over Medical Identifiers: Patient’s should know details about their prospective employers before giving their medical identifiers. Providers should train staff about the correct use and management of medical identifier information. Use tamper resistant prescription pads.
Raise Awareness with Patients: Providers should educate patients about medical identity theft, and its grave consequences.
For More Information visit: https://www.ccaillinois.com
