Suspect a dishonest patient? Take steps

If a patient gives untruthful information to registrars to avoid paying for services, this fraud can result in dangerous clinical outcomes as well as lost revenue.

Patient access leaders at University of Colorado Hospital in Denver have devoted a great amount of time to identity theft and identity fraud, says Bob Potter, RN, manager of access and preadmissions. A multi-disciplinary task force included compliance, admissions, health information management, ambulatory services, emergency department, and patient representatives. "As a result, a policy was developed that was compliant with the anticipated Red Flag Rules," says Potter.

Staff were educated on the following items in the policy:

identification of perpetrators, using age discrepancies, medical history, signatures, mismatches in registration system, or registration under a different name from previous hospitalization;

use of an online reporting system;

registration of a known perpetrators or victims for future admissions;

close collaboration between campus security and local police.

"This education has resulted in four apprehensions by the police for known perpetrators of identity theft or fraud," says Potter.

Special attention is paid to collecting accurate identity and financial information when evaluating a patient for the Colorado Indigent Care Program or charity programs, adds Potter. "In general, staff has been accepting of our policy. We have brought it down to the level of how it would affect them if they were the victims of identity theft," he says. Staff have noticed cases of a duplicate social security number or an obvious age discrepancy. "They then notify me, and I begin the investigation," says Potter.