ED registrars often ID 'suspicious answers'

Red flags signal possible fraud

Some emergency department (ED) patients are destitute, drug-seeking, or have nowhere else to obtain care, and they might pass themselves off as others to obtain insurance coverage, says Marsha Kedigh, RN, MSM, director of admitting, emergency department registration, discharge station, and insurance management at Vanderbilt University Hospital in Nashville.

"We have had a patient present himself as his brother, because he had the brother's insurance card," says Kedigh.

Other patients have provided a date of birth with one digit off, she says, or they have given variations of their name spelled slightly differently to allow the registration system to create a new medical record number. "They personally may not understand our registration system well enough to know that a new medical record number is being created," explains Kedigh. "They just want to provide enough false information to 'trick' the system with a new registration."

Vanderbilt's registrars perform a careful check to validate the patient's date of birth, social security number, name spelling, and address, says Kedigh. They always ask for photo identification. "If there is any question as to the validity of the information, we will set an 'ID' flag in our registration system," says Kedigh.

In some cases, patients are the ones who request that their own accounts be flagged because they are victims of identity theft. "The flag provides information to the registrar of what to do if a person comes in using that name, such as making sure to get a photo ID, or validating a date of birth," Kedigh says.

Registrars also notify a manager about the situation so it can be resolved with the patient present, and they notify security if there is concrete evidence the patient is being fraudulent.  "Oftentimes, the staff are the ones who recognize suspicious answers with the registration process," says Kedigh. "With these scenarios, the investigation is low-key. If something is found to be suspicious, the staff get security involved."

For example, a patient's social security number might be off by one digit, and that same patient can't present a valid ID. In a scenario such as this one, "if resolution cannot occur while the patient is present, we take the case to our patient identity subgroup," Kedigh says. "They work the case to resolution and memo the particular account in our registration system as to the findings."  

Sources

For more information on emergency department registrations involving possible fraud, contact:

• Marsha Kedigh, RN, MSM, Director of Admitting, ED Registration, Discharge Station, Insurance Management, Vanderbilt University Hospital, Nashville, TN. Phone: (615) 818-9620. Fax: (615) 343-5922. E-mail: marsha.kedigh@Vanderbilt.edu.

• Joyce L. Predmore, Associate Director, Patient Access Services, Ohio State's University Hospital East, Columbus. Phone: (614) 257-2392. Fax: (614) 257-2194. E-mail: Joyce.Predmore@osumc.edu.