Know Your Patient Preventing Fraud in Healthcare

KYP or Know Your Patient is the security measure used in the health care sector. The Healthcare industry is brutally being victimized by fraudsters. There have been up to 30% of the data breaches recorded over the last 10 years in the healthcare sector. These data breaches have affected millions of employees and customers. This type of fraud can take up many forms including credentials stealing and data disclosure to the stolen devices. The medical database must be highly protected as it contains vulnerable information of the patients including their medical history, identity information, SSN number, and their insurance details. Know your patient is the perfect solution to fight these crimes.

Fraud and Data Breach in Healthcare

According to the research, 34% of healthcare data breaches is due to the unauthorized control of access data. Ransomware and malicious activities are also the reason for the compromised data. Fraudsters can put these attacks into the system and steal all data. Medical data is of so much interest to the criminals as it has a very high value if sold in black.

A report suggests that there has been a huge number of data breaches in the USA due to system hacking, theft, and unauthorized data access. The huge number of data breaches have impacted the country’s economy as well as the repute of the country, Anthem breach is a known breach that affected about 78.8 million including employees and patients. Due to this, the insurance company had to face a lawsuit of $115 million. Hospitals, insurance companies, and other health-related service providers are required to take strong measures to combat these cyberattacks. They are also required to comply with the regulations provided by the regulatory authorities of their jurisdiction.

Importance of Know Your Patient

The concept of Know Your Patient is similar to Know Your Customer (KYC). While KYC is a defence for banking and financial institutions, the know your patient requirement is for healthcare to protect it against data breach and fraud. Know your patient is an identity verification measures that require the healthcare facilities to verify the identity of all their patients.

Healthcare is in dire need of such measures that can digitally secure the identity of the individuals and all the patients are verified to ensure that no identity thief is using a stolen identity to get benefits. Patient verifications help healthcare to not only identify the identity thief but also to capture prescription fraud and fight data breaches.

How Know Your Patient Solution Works

For patient identification, the online identity verification process is carried out when the patient is being onboard. This solution is extra handy while opening an account online for an online medical store or hospital portal. The solution is fully automated and will verify the identity of the patient in no time.

The patient will be required to upload a picture of their government-issued ID documents including their passports, date of birth, ID card, or even driving licence. The documents that have a photo on them are preferable. Then the person is asked to upload their selfie in the portal. First, the AI-powered know your patient solution will verify the photo on the ID card against the selfie to ensure that the person is the same.

Then the document verification process occurs on the ID document to be sure of how legit the document is. The AI-powered solution is trained to identify and capture any fraudulent ID documents and it will alert the hospital authorities if a fake tampered or stolen ID is present to it.

Then age verification checks are performed to verify the age of the patient. This check is particularly necessary as it ensures that no minor becomes the victim of identity theft. It is also done to ensure that the minors do not access any age-inappropriate substances including prescription drugs.


Use Cases of the Know your Patient Solution


  • Patient’s Data Privacy

HIPAA, The Health Insurance Portability and Accountability Act has put certain guidelines to secure the patient’s data and all the healthcare facilities are required to follow it on a serious note to secure the patient data. The flow of data should be observed and to avoid any breaches and the integrity of the facility. If the data is lost, the patient and the hospital can face a lot of harm. Any facility that deals with Protected Health Information (PHI) must take measures to protect the private data of their patients or else they will have to face serious fines.

  • Insurance Fraud

Once the data of the patient is stolen, it affects them not medically but also financially. Insurance details can get into the hands of fraudsters and they can use it for their malicious intent. A fraudster can get free treatment while the victim will have to pay for the expenses. The medical industry needs to ensure their patient’s identity before treating them so only the right person gets the treatment while the fraudster is captured.

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