Texas biometrics project targeted Medicaid program

Technology to reduce fraud tested

A biometrics pilot project at Harris Methodist Fort Worth Hospital was virtually seamless in terms of staff training and patient participation and showed great potential for reducing fraud and enhancing customer service, says Jeff Ferrell, CHAA, CHAM, director of the Texas Health Resources (THR) patient access intake center in Arlington.

The Harris Methodist project was part of an initiative by the Texas Health and Human Services Commission to test technology to reduce fraud and abuse, adds Ferrell, who was manager of patient access services at Harris Methodist at the time.

Harris Methodist Fort Worth, a 600-bed tertiary care referral hospital, is located in Tarrant County, one of six Texas counties that participated in the Medicaid Integrity Pilot, he says. The program was developed, Ferrell notes, to prevent two types of fraud within the health care system: medicaid identity fraud and phantom billing.

"There were several vendors that got a contract [to participate]," he says. "They wanted to decide which had the best practice." The participating hospitals were not told which vendor's technology they were using, Ferrell notes.

Under the terms of Harris Methodist's part of the project, he explains, 100,000 Medicaid patients in Tarrant County were issued a Texas Health and Human Services Commission Medicaid Integrity Card. In addition to the words, "State of Texas," the state seal, and the participant's name, Ferrell notes, the card contained a "smart chip."

"It was up to the hospital or the first [provider] to see the patient to capture the person's fingerprint on the card the first time," he says. A number of physicians throughout the state also participated in the project, Ferrell adds.

Hospitals were given two kinds of equipment to use as they deemed appropriate, he says. One was a keyboard with a card reader and an accompanying identification pad that looked like "a little hockey puck," with a piece of glass on top where patients put their fingers, Ferrell says.

The other option, for those who didn't want to install new keyboards, was a stand-alone card reader with a small "wallet" on top into which the card could be slipped and above that a place to put the finger in, he adds.

Harris Methodist used both devices — the keyboard in the main registration areas and the stand-alone reader for the emergency department, Ferrell notes. "For the ED, it was easier to have the little 'wallets' on a kind of cord connected to the computer on wheels that was used for bedside registration."

At Harris Methodist Fort Worth, the biometric application and readers were deployed to 22 separate access areas, he says.

During the six-month pilot, Medicaid recipients being admitted to the hospital were asked if they had their "integrity cards." If they did — not all Medicaid recipients were issued the cards — the registrar took the card and inserted it in the slot in the keyboard or in the stand-alone reader, Ferrell adds.

The device indicated if the person was a first-time user from whom the hospital needed to capture a fingerprint, he explains. "If so, the person would make a swipe on the little hockey puck of the left and the right index finger, in case one couldn't be read."

The information on the smart card then printed an algorithmic reproduction of the fingerprint, which is "like a 99% match," Ferrell says. Registrars could see on the screen if it was "a good match and a good capture," he notes, and if not, would ask the patient to move his or her finger and do it again.

When the device was gathering the algorithm, there normally would be a red or green light indicating the result, Ferrell says, but during the pilot the user never knew if any given card was a match or not.

The pilot, he explains, was designed to be a test of the technology, so that any bugs could be worked out, and was not to be used to turn anyone away.

The way the technology is designed is that the transaction is recorded as a biometric match or failure, Ferrell says. "The data is stored on the back-end server and used for reporting and tracking fraudulent transactions."

Patients who had the cards were very receptive to the process, Ferrell adds. "From the patient's point of view," he points out, "being able to just pop this card out rather than pull out a big piece of paper [indicating Medicaid status] and have people say, 'Oh, they're on Medicaid,' was a positive experience."

The long-term goal of the Medicaid Integrity Pilot, Ferrell says, was to link various state programs — such as the food stamps program or the Women, Infant, Child program — to the same smartcard, thereby minimizing costs and increasing convenience to Medicaid recipients.

The process of checking smart cards and capturing fingerprints of Medicaid recipients was noticed and asked about by other patients, he notes. Simply knowing that such procedures are in place, Ferrell suggests, likely would serve as a deterrent to those who might otherwise try to use false identification.

(Editor's note: Jeff Ferrell can be reached at JeffFerrell@texashealth.org.)