Take steps to ward off ID fraud on the front end

Being aggressive pays off

Undocumented individuals may have a single Social Security card and pass it around to several people. In other cases, an electronic medical record may describe a patient of a different age or gender than the person standing before you.

There is no question that patient access staff are seeing many more cases of patients with fraudulent identities. In addition, some patients are asking for help because they are victims of identify fraud.

"More frequently, we are being asked by patients to put an alert on their account because they have been subject to identify fraud," says Alesha N. Delgiacco, interim manager of inpatient access at Lancaster (PA) General Hospital. "They want to ensure that we are asking anyone who is using their name for photo ID."

Patients at Lancaster General have, in fact, used the names of their identity theft victims — not just on one occasion, but many times. "Due to the frequency of the patient's visits, our team will question, 'Weren't you here last week? You look familiar,'" says Delgiacco.

"We try to deter them from using another's persons ID," says Delgiacco. "I commend my staff on their teamwork and wanting to get it right, as well as the nurses who clue us in to discrepancies in patients' stories."

Get the word out

"We've been dealing with this for over a year, but it seems like it's happening more often now," says Linda Durst, medical information services operations manager at OSF Saint Francis Medical Center in Peoria, IL. "We know there is a problem. We see it sometimes once or twice a week."

Identity theft occurs mainly in the ED, and less rarely in the hospital's urgent care center or outpatient testing sites. "We had to update our policy and procedure and make sure everybody was on the same page," says Durst.

The department has taken steps to gain a reputation for being tough against identity fraud. "I think with us being aggressive about it, we are seeing a decrease. So possibly, the word is getting out," says Durst.

Previously, if registration staff thought that identify fraud was occurring, they would tell the patient's nurse. The nurse would attempt to get the correct information, but the first priority is always clinical. "We never wanted to not treat a patient. That was our first concern. Also, we had concerns about violations of EMTALA [the Emergency Medical Treatment and Active Labor Act]."

After the patient was treated, the clinical person at that point would call the police. Under the new policy, however, hospital security staff are called first.

"They come down and try to get the person to own up to who they really are before we call the police. It is just an added step," says Durst. In some cases, seeing a uniformed person makes the patient admit to the identify fraud.

If something doesn't seem quite right to registration staff, they excuse themselves. A different registrar comes in and asks the patient for the same information, such as a Social Security number.

"We ask the questions again to see if they give the same answer," says Durst. "When we start questioning them, sometimes they will say they're going to get their wallet in the car, and they never come back."

In some cases, law enforcement have become involved. "We've actually had one patient bring us back money, because that was part of his deal with the court," says Durst.

If a patient becomes upset, registrars stop questioning that person and contact security. "They know their limits, and know to back off if anybody's riled up," says Durst.

In the ED, the patients committing identify fraud typically aren't critically ill, says Durst. Most are seeking pain medications.

"Staff explain to them that it is very important that we are treating who we think you are. We try to help the patient understand that if you give us the wrong identity, we could do harm to them because it's somebody else's medical record," says Durst.

Identity fraud is part of orientation and precepting of registrars. Staff use scripts and are encouraged to involve supervisors if they feel at all uncomfortable.

"We really work together on this issue, because it is a little unnerving," says Durst. "We want to be sure that we don't falsely accuse anyone. But we're pretty aggressive on this."

If patients don't want to give their name because they can't pay for the care, they might qualify for federal assistance programs or charity, adds Durst. "We are seeing an increase in self-pay patients, especially in the ED," she says. "We really encourage them to fill out the Sisters Charity within the hospital. If they are eligible, they can get all levels of care with that."

Linda Swanson, registration coordinator at Mercy Medical Center in Oshkosh, WI, says that her hospital has seen "just a few" instances of fraud on the front end, from using a fake name to using another person's identity and insurance.

"This, of course, can have many negative issues for the 'true' patient, from wrong information on their medical files to claims submitted to their insurance," says Swanson. "There may be complete write-offs for patients who are using fake names, who most of the time have no insurance."

In response, the hospital system has developed a policy of asking for picture identification from patients who do not have insurance. "We've found that helps deter patients from using a fake name and information, at times," says Swanson.

For patients who report having had their identity stolen, staff can put in a pop-up message. Anyone doing a registration on future visits will then check for identification.

"When identity theft does occur, it takes much investigation and work to clear up, from changing the name on the records for that visit, test results, to holding the billing until things are cleared up," says Swanson.

To guard against identity theft, the patient's and guarantor's Social Security numbers were removed from all registration forms and labels. "We still capture these, but they do not show up on any paperwork," says Swanson. "We also shred confidential paperwork or anything that would have a patient's name or information on it."

Staff also are trained to always keep paperwork turned over whenever a new patient enters their office. "Small items like these do help to deter identity fraud/theft," says Swanson.

[For more information, contact: Alesha N. Delgiacco, Interim Manager: Inpatient Access, Lancaster General Hospital, 555 North Duke Street, Lancaster PA 17604. Phone: (717) 544.4029. E-mail: andelgia@lancastergeneral.org; Linda Durst, Medical Information Services Operations Manager, OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, IL 61637. E-mail: Linda.M.Durst@osfhealthcare.org.]