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Growing trend of identity theft poses safety and billing loss threats
Prevention particularly difficult in emergency setting
Just as identify theft has been steadily increasing in the general populace, so has it grown in the medical setting, with the ED perhaps feeling the greatest impact of all. At CoxHealth, which operates three hospitals and more than 50 clinics in Springfield, MO, 1-2% of the system's patient population have an identity theft issue, and most of the incidents of medical identity theft come through the ED, says Betty Breshears, MHA, the vice president of corporate integrity.
John Archer, RN, director of the ED in Cox South Hospital in Springfield, says, "We have seen a rising problem in the last five years of folks trying to use other folks' insurance. For example, they might hand us a relative's card."
Archer says identify theft poses a dual threat in the ED. First, of course, is the potential loss of revenue. Breshears points out that in non-profit hospitals, the facility in most cases would care for these patients anyway, even if they had given their true identifies. Therefore, she says, it doesn't alter the financial result to a significant degree.
The more serious concern involves the actual care of the patient, Archer says. "Think about someone who checks in with another ID and who has a long history of health problems," he says. "We'll do our tests under that name and the records of that other person, and we could potentially kill someone if we give them a drug they're allergic to or if we perform the wrong type and cross of blood." Another situation is the inability to reach the patient with a follow-up call to inform them of a negative test result, he says.
Beyond these issues is the added pressure of the "Red Flags Rule," a Federal Trade Commission (FTC) policy that many businesses and organizations, must implement a written identity theft prevention program designed to detect the warning signs, or "red flags," of identity theft in their day-to-day operations. Fortunately for ED managers and other health care leaders, the FTC has delayed its compliance deadline until Dec. 31, 2010, to consider complaints that physicians should not be held to the same standards as other creditors in guarding against identify theft.
The physician complaints are well-founded, says Darria Long Gillespie, MD, MBA, a resident in the Department of Emergency Medicine at Yale University in New Haven, CT. Such a program will be extremely complicated in the ED, "as patients purposefully give us incorrect information frequently for many reasons aside from identity theft, so it would be even more difficult to differentiate one from the other," Long Gillespie says.
One common reason for giving invalid information is that they are not legal citizens and don't want the ED to be able to track them, she says. "Another very common reason is that patients don't want to pay the bill and don't want to be tracked down for the bill of the ED, so they purposefully give incorrect phone numbers, addresses, and so on," Long Gillespie says.
Given these factors, "we're totally accustomed to patients lying about their demographic information," she says.
Proceeding with plans
Notwithstanding these challenges and the delay of Red Flag Rule implementation, several EDs are proceeding quickly with their own plans to combat identity theft.
At Cox South, "a photo ID is now required by the registration folks to confirm their identification," says Archer. "If they can't provide it although it will not delay or effect treatment they will be flagged as such and will need to confirm their identity at a later time." After the patients show their IDs, they also are asked to confirm they have some knowledge about things such as their date of birth or the last four digits of their social security number, he says.
The ED at St. Joseph Hospital in Bangor, ME, just recently started to ask for positive ID, adds Charles F. Pattavina, MD, chief of emergency medicine and a member of the public relations committee of the American College of Emergency Physicians. "For a long time there was a general feeling that, especially at a patient's time of need, we did not want to press too hard for things like a driver's license or ID or give them the impression other things are as important as their care," he says, "But now it's become apparent that people are trying to use other individuals' health care benefits."
At Cox South, there are discussions under way about adding a new policy that would involve taking a photograph of every patient who registers in the ED for the first time, Archer says. "Some EDs in larger cities have gone to that level, and I see it happening in the next two or three years here or even sooner," he says. The process is not complicated, Archer says. "The registrar would take the picture, not unlike the process you go through when you open a new bank account. They hold up the camera next to the computer and snap," he explains.
That idea is probably a good one, says Pattavina, "especially if you explain to the patient that you're trying to prevent somebody coming in and claiming to be them."
For more information on preventing identify theft in the ED, contact:
Manager, registrar develop policy
Fitting best practices into the system
The new identity theft program for the ED at Cox South Hospital in Springfield, MO, was a team effort between the ED manager and the registrar, says John Archer, RN, director of the ED.
"We worked on the changes collaboratively," Archer says. "As best practices come up, we sat down and talked about how to fit them into our system and operational flow."
The clinical staff is involved in the new process, which includes requesting a photo identification of all patients, only when patients arrive by ambulance, he says, so the new policy did not involve a significant amount of training. "However, they are our eyes and ears," Archer says. "If they see or hear something that just doesn't fit, they bring it to the attention of the registration staff or security as they have already had to do several times."
What are some of those things that "just don't look right?" Beth Keithis manager, health care provider consulting, at Affiliated Computer Services in Dearborn, MI, a company that performs Red Flags Rule assessments and will help health care organizations put policies and procedures in place to deal with the issue. "The cases I have been involved with have mostly had to do with a birth date being off," Keith says. Other common tip-offs include non-existent social security numbers or addresses, photo IDs that have been altered or don't match up with the person, or cases in which patients say they have left their photo IDs at home.
Whatever policy you develop to detect possible identity theft, it's imperative that the ED manager be heavily involved, Archer says. "All things that happen in the ED no matter who is involved ultimately come back to me," he explains, "so while it may not be my number one focus, I have to make sure people do the right things to protect our patients."
For more information on protecting your ED against identity theft, contact: