Health record identity theft a growing concern among medical providers

Medical identity theft can cause a victim’s medical record to get corrupted with the thief’s, potentially compromise their medical care and lead to false billing.

In this era when health insurance is gold, the fortunate need to be aware.

Taking the theft one step further, corrupted medical records can lead to denied coverage down the road.

The potential harm can be as far-reaching as the more common identity theft for monetary purposes, but attention to medical identity theft has been scant in comparison, according to a January report done for the U.S. Department of Health & Human Services.

That could change May 1 when new rules kick in, requiring hospitals, doctor’s offices and clinics to have policies in place to detect and deal with medical identity theft.

The healthcare industry isn’t the sole target of the upcoming Red Flags Rule; , the intent is to cover all industries that provide “credit” to consumers and guard against all forms of identity theft.

The new rule is a consequence of the 2003 Fair and Accurate Credit Transaction Act signed by President Bush to protect consumers. Folding in protection against medical identity theft signified a commitment to broad consumer protections by the federal government.

The new rule was intended to take effect Nov. 1, 2008, but the federal government agreed to a delay after the American Medical Association (AMA) said doctors weren’t sufficiently informed the rule would apply to them.

In the end, the AMA didn’t prevail. The federal government set the May 1 deadline and is offering a six-month grace period before enforcing.

Moreover, the AMA contended healthcare organizations were not “creditors” in the true sense. The AMA also said healthcare providers already were in compliance because of privacy protections under the Health Insurance Portability and Accountability Act.

Compliance involves extra training of patient registration personnel in spotting fake IDs from real identification cards and verifying information against existing internal records.

Southwest Florida hospitals say they don’t take issue with the new rule.

At the same time, hospital officials say thieves can always find a way to get what they want. The emergency rooms are the most vulnerable when treatment first, identify yourself later, is often the case because of life-threatening injuries.

Most of the hospitals have purchased extra computer application that can do additional patient verification checks, but that measure wasn’t necessarily prompted by the Red Flags rule.

“People come in and know how to use the process,” said Todd Lupton, chief financial officer of the Physicians Regional Health Care technique in Collier County.

“A lot of people on Medicaid are passing around their Medicaid card,” said Stanley Padfield, director of health information management and the privacy officer for the Lee Memorial Health technique in Lee County. “They keep it in the relatives. Things like that happen. The Red Flags Rule is not prepared to deal with it.”

One agency’s survey nationwide found that 4.5 percent of the 8.3 million victims of identity theft also experienced some degree of medical identity theft.

From a numbers standpoint, agencies grasp at how often medical identity theft occurs.

“That is the risk in any organization,” said Kelly Daly, director of internal audits/compliance and the privacy officer for the NCH Healthcare technique in Collier County.

Theft of patient information by employees is another scope of the problem, though hospital officials say that's a tough one to deal with.

A safeguard technique at NCH is audit application that tracks employees who have opened a patient’s medical record.

The problem of internal theft hit home in Southwest Florida in September 2006, when a front table clerk of Cleveland Clinic in Weston was indicted and accused of stealing personal information, including Medicare and Social Security numbers, of over 1,100 patients of the then- Cleveland Clinic in North Naples off Pine Ridge Road. The employee, a 22-year-old woman, sold the information to her cousin for false Medicare billing.

The theft occurred sometime between May 2005 when the woman was hired and before her indictment in September 2006. seven months before her indictment, the Naples hospital was sold to Naples-based Health Management Associates, which later changed the hospital’s name to Physicians Regional.

The Red Flags rule is prompting additional training to patient registration personnel for spotting suspicious identification or fake cards, said Lupton, of Physicians Regional. At the same time, the hospitals at Pine Ridge and Collier Boulevard have yet to see fake passports or driver’s licenses, they said.

A breakdown in the technique is possible when the application technique is down or when there isn’t patient history in the process, they said.

If employees are presented with suspicious identification or given questionable information, a supervisor is called and the patient will be questioned. The hospitals have ways to verify data from previously obtained information and to check out insurance cards, said Shari Boyer, executive director of patient financial services for Physicians Regional.

At the Lee Memorial System’s one hospitals, the patient database has 1.2 million names and identifying information. When information a patient has given doesn’t match up with what is on file, a new patient record will be created until there is a resolution, Padfield said. The purpose is to avoid corrupting an existing patient’s medical record.

“You cannot stop the care no matter what. You treat them but they are not put in the database as they say who they are,” they said.

In general, the suspicious person’s care turns into bad debt because they didn’t actually steal services, they said.

What people are seeking with medical identity theft is free health care but theft doesn’t occur when a suspicious patient’s information is kept out of a legitimate patient’s file, they said.

At the NCH process, which operates Downtown Naples and North Naples hospitals, patient registration staff are undergoing more training for the Red Flags rule, said Sandy Wood, operations director of revenue cycle.

In addition, NCH is working with a vendor to potentially subscribe to a database technique that's used by the federal government to determine phone records and addresses, Daly said.

“It can tell us if a number is a phone booth or if an address is a vacant lot,” they said, adding that the decision hasn’t been made yet whether to buy the program, which goes beyond the requirements of the Red Flags rule.

Prime Health Network and Its Patients Thrive in Tough Economic Times

PRNewswire via COMTEX/ ----In an economic environment where lots of healthcare providers are facing steep challenges, Prime Health Network and its patients are thriving with help from InstaMed. By utilizing InstaMed's industry leading healthcare payments network and platform, Prime Health Network has increased patient collections and reduced their costs related to collections, while also improving the patient experience at each of their eleven locations.

As patient financial responsibility rises due to increases in deductibles and fundamental changes in health plan benefits, providers face the increasingly difficult challenge of managing patient collections and patient satisfaction. Legacy collection processes and solutions have proven inadequate in this new era of increased patient responsibility. By implementing InstaMed's solutions -- which include eligibility, point of service estimation, payment processing, clearinghouse services and online bill payment -- in their front and back offices and on the internet, Prime has seen a 24% increase in patient collections as well as a 10% reduction in their costs to collect, post and reconcile patient payments.

Healthcare providers today are seeking integrated healthcare and payment processing financial services technologies that go beyond what standard payment processors or healthcare clearinghouses currently offer. it's also increasingly relevant that these solutions are certified and compliant with the security standards and regulations of both the healthcare and financial services industries. Additionally, providers must implement new policy initiatives focused on patient payment responsibility, while demonstrating sensitivity toward positive patient relationships and satisfaction metrics.

"InstaMed's impact on our practice was eight of the highlights for our business in 2008," stated Mary Jo Shields, Executive Director at Prime Health Network. "With InstaMed, we've simplified our billing method which has allowed us more time to focus on providing quality care to our patients. The ability to check patient eligibility, in addition to offering patients flexible and convenient payment options using a payment card has improved our workflow and contributed to the reduction in our costs."

Bill Marvin, President and CEO of InstaMed stated, "We are happy to see the results that Prime has achieved, both operationally and with regard to patient satisfaction. InstaMed's mission is to transform the healthcare payment method and generate a better experience for all. they are thrilled to be working with Prime and they look forward to their continued successes in 2009."

About Prime Health Network

About InstaMed

Prime Health Network is Delaware County, Pennsylvania's largest independent primary care practice, with ten locations -- nine in Delaware County and eight in West Philadelphia. Prime offers convenient office hours, prompt scheduling, and the services of the area's leading medical institutions. Not owned or operated by a large health technique, Prime is able to direct patients care to the most appropriate health care facility to meet their needs. Visit Prime on the net at www.primedr.com.

InstaMed is the industry leading healthcare payments network and platform. InstaMed's mission is to transform the healthcare payment method for healthcare Providers, Payers, Banks and Patients so their payment experience is simple, convenient, reliable and secure. InstaMed processes all of the healthcare and payment transactions in the healthcare revenue cycle and offers patent pending, integrated healthcare and payment transactions that accelerate the healthcare payment method and reduce the administrative costs to all parties. InstaMed currently supports the healthcare payment processing needs of over 700 hospital and clinic locations; practice management vendors and billing services representing over 50,000 providers; and hundreds of healthcare payers of all sizes. InstaMed is registered with Visa and MasterCard and is certified as a Payment Card Industry Data Security Standards (PCI-DSS) Level eight Service Provider. InstaMed is also fully accredited by the Electronic Healthcare Network Accreditation Commission (EHNAC: undefined, undefined, undefined%) as a healthcare clearinghouse. InstaMed is an AHIP Solutions Partner (America's Health Insurance Plans), a member of the C.O.R.E. Initiative (Committee on Operating Rules for Information Exchange), the Medical Banking Project, ASC X12, HBMA (Healthcare Billing & Management Association), Electronic Payments Network ACH Association Services, MGMA's Project SwipeIT (Medical Group Management Association) and WEDI (Workgroup for Electronic Data Interchange). Visit InstaMed on the net at www.instamed.com.

An Obama administration proposal to bill veterans' private insurance companies for treatment of combat-related injuries

An Obama administration proposal to bill veterans' private insurance companies for treatment of combat-related injuries has prompted veterans groups to condemn the idea as unethical plus powerful lawmakers on Capitol Hill to promise their opposition.

Nevertheless, the White House confirmed yesterday that the idea remains under consideration, plus Chief of Staff Rahm Emanuel plus leaders of veterans groups are scheduled to meet tomorrow to discuss it further.

Veterans groups said the adapt would be an abrogation of the government's responsibility to care for the war wounded. plus they expressed concern that the new policyowner would make employers less willing to hire veterans, for fear of the cost of insuring them, plus that insurance benefits for veterans' families would be jeopardized.
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The proposal -- intended to save the Department of Veterans Affairs $530 million a year -- would authorize VA to bill private insurance companies for the treatment of injuries plus medical conditions related to military service, such as amputations, post-traumatic stress disorder plus other battle wounds. VA already pursues such third-party billing for conditions that are not service-related.

The chairman of the Senate panel, Daniel K. Akaka (D-Hawaii), said a majority of the committee members say the plan is fundamentally unfair.

Lawmakers explicitly ruled out the proposal yesterday in budget recommendations from the Senate plus House veterans' affairs committees.

"America's veterans plus their families pay the true cost of war everyday, plus they must pay for the care plus benefits they have earned. I look forward to working with my colleagues plus the Administration to pass a budget worthy of their service," Akaka said in a statement.

Sen. Patty Murray (D-Wash.), a senior member of the Veterans' Affairs plus Budget committees, warned VA Secretary Eric K. Shinseki last week that the idea would be "dead on arrival," plus he vowed yesterday that any budget containing the provision "is not going to pass."

White House press secretary Robert Gibbs said yesterday that the Obama administration has not made "the final . . . decision on third-party billing as it relates to service-related injuries."

"The VA has an obligation to pay for service-related care, plus they should not be nickel-and-diming vets in the scheme," he said in an interview. "This proposal means that relatives members will be hurt because, if a vet meets the maximum [benefit amount] for their insurance, their wife plus children would not be able to get insurance [benefits] anymore. . . . God forbid a wounded vet from Iraq has a wife who gets breast cancer."

VA plus the Office of Management plus Budget did not respond to requests for more details on the proposal.


At the same time, Gibbs noted that the administration is seeking an 11 percent increase in discretionary spending in the VA budget, a decision lawmakers plus veterans groups have praised. "This president takes seriously the needs of our wounded warriors that have given so much to protect our freedom on battlefields throughout the world," Gibbs said at a White House news conference.

It is a medical insurance nightmare that began with a physician simply trying to make things easier for a patient.

It is a medical insurance nightmare that began with a physician simply trying to make things easier for a patient.

A simple favor turned into money seizures, bill collections, and a lawsuit that were spinning out of control.

So, it was time to Get Gephardt.

The doctor patient relationship can be personal.

So personal that I know plenty of kind doctors will go out of their way to provide special help to a patient who is in particular need.

In this case, such a personal favor turned into a medical insurance nightmare for the patient...

But they does...

With the energy Tiffany Schoenfeld displays to supervise her babies around her home, you wouldn't suspect that they has a heart condition.

Back in February of 2007, Tiffany wound up here at the University of Utah Medical Center Adult Congenital Heart Clinic, where Tiffany's insurance covered treatment by only one of the doctors. Her insurance did not cover an electrocardiogram heart check.

But, in Tiffany's require, the doctors worked out a deal.

"They all came back in and said, oh, it's your lucky day," Tiffany says.

The doctors arranged that no matter what happened, all of her treatment would be billed through that one doctor who took her insurance.

The first bill from University Healthcare rejected by the insurance company came to $978...And Tiffany sent in her appeals.

But then someone filled out insurance forms that sent the bill through the wrong doctor. and that was the beginning of a 2-year medical insurance nightmare.

"None of it was supposed to be charged," they says.

But after Tiffany appealed to the University of Utah Medical Center, another bill came...with late charges.

So, this time, the nurse went to the billing department to tell them about the mistake.

But that didn't work, as Tiffany found out when the state of Utah seized her money.

The state seizure was $500 dollars. But, by now, the bill had now grown to $1400.

That's right. The state of Utah with no trial, or even a hearing, can seize a citizen's tax refund. The Utah Attorney General acts as the collection agent if a state institution, like the University of Utah Medical Center simply says a citizen owes money

& that brought tiffany to Second District Court in Layton for mediation with Express Recovery's lawyer.

So, this time, the University of Utah Medical Center sent the bill to their collection agency, Express Recovery.

Tiffany was armed with a letter. it is from the nurse who tried to stand up for Tiffany four times before. The nurse wrote that they "was personally present" when the doctor said they would be "waiving his fee." Tiffany gave the letter to the lawyer, but that didn't do any nice.

The lawyer sent Tiffany back to mediation, and when they tried to explain again Experess Recovery Lawyer Edwin Parry sued Tiffany. Now Tiffany needed a lawyer. It cost her $130 an hour on a bill they rarely owed.

I called Chris Nelson, the head of Public Affairs at University of Utah Healthcare. and over night, this medical insurance nightmare was over.

A court date was set, but Tiffany's lawyer got the trial postponed...and that's when they called me...nearly 2 years later.

"You know, this went to the highest level of our hospital's administration. and as everyone looked at this, it was kind of an obvious thing. Yeah, this was not handled well...so they need to do what's right for the patient," Nelson says.

& within days, a check came from university hospital for $503. The amount seized so long ago from Tiffany's state tax refund.

“For every one Tiffany,” Nelson says, “unfortunately, there are probably 40 or 50 other cases where folks are trying to maybe not pay their bills. But they need to not be brushing everybody with the same stroke."

& that lawsuit to collect the rest of the money is dropped...Tiffany got lumped into a collection method that sometimes doesn't look closely at individual cases.

& University of Utah Healthcare is paying all of Tiffany's attorney fees.

So, the problem here stemmed from a doctor trying to do a patient in need a favor, but when the doctor did not carefully follow his own paperwork to have it properly billed, the favor wound up as a billing method medical insurance nightmare.

If you have something you think i need to investigate, the number is 801-839-1250 or my email address, gephardt@kutv2.com.

Eicart Medical Billing System, LLC, a medical billing service offering doctors easier medical insurance claims billing

Indianapolis, In (PRWEB) March 9, 2009 -- Eicart Medical Billing technique, LLC, a medical billing service offering doctors not as hard medical insurance claims billing, has opened offices in Indianapolis, Indiana. Tracie Williams, founder of the service, said that the new company will handle the entire insurance billing service for all kinds of medical providers including filing claims, follow-up mediation for rejected or denied claims, and collecting unpaid claims.

Eicart Medical Billing technique, LLC, a medical billing service offering doctors not as hard medical insurance claims billing, has opened offices in Indianapolis, Indiana. Tracie Williams, founder of the service, said that the new company will handle the entire insurance billing service for all kinds of medical providers including filing claims, follow-up mediation for rejected or denied claims, and collecting unpaid claims.

Electronic Media Claims (EMC) is a well established process of billing. In fact, over 90 percent of hospitals use EMC, while only 15 percent of doctors have taken advantage of the procedure. Eicart Medical Billing technique, LLC, hopes to enable individual practices to take advantage of the electronic highway.

Medial billing service offered:

"We use electronic claim filing," Tracie Williams added. "This reduces the turn-around time between filing the claim and receiving payment from several weeks to a few days." The service also has the option of filing printed paper claims.

"With new and ever-changing state mandates, filing insurance claims has become a major part of office procedure for today's health care providers. Eicart Medical Billing brings expertise in this field, enabling medical offices to once again concentrate on patients instead of on insurance", said Williams. "With health care reform, the
problems can only become more complicated, which is why our service is essential."

Barbara Lofton is fighting many battles: cancer, high medical bills and now very little coverage.

Barbara Lofton is fighting plenty of battles: cancer, high medical bills and now little coverage."I always had insurance, had plenty of insurance," said Lofton. "You get cancer, you don't have a job, and your insurance is gone."Lofton isn't just a patient; she's a symbol of the struggle facing so plenty of people in middle Tennessee.Jody Rowland runs the billing department at Vanderbilt's Ingram Cancer Center."We see it from all different aspects, and it's been greater in the last few months," said Rowland. "We tell the patient when they walk in that they stress about their financial conditions; they don't have to stress about that. they stress about getting well."Despite reassurances, patients are stressed.Experts said if you get sick, be upfront -- don't hide your financial situation from your medical provider. they can immediately identify ways for you to get drugs for free and help to determine your eligibility for government programs. TennCare, for example, offers special aid to breast and cervical cancer patients.There are even co-pay assistance programs."People always assume that seven times they lose a job and lose their insurance that their doctor no longer wants to see them, that they no longer afford to come and get treatment," said Rowland. "That's the No. 1 mistake. there's ways that they can work in tandem together to make it happen."And then there's the advice that insurance can't buy."You have to have a positive attitude. No matter whether you have $100,000 in bills or $10 in bills, you still have to look at the prospects of what's out there to help you," said Lofton.Medical providers are aware of the strain, and some, like Vanderbilt, have added financial counselors to their staff to help map out designs.Another worry for patients is paying their everyday bills. Special money are in place to help them avoid missing automobile and other payments.

Technology companies and physicians now seem to be on the same wavelength. Companies finally are selling what doctors want to buy.

For more than two decades, technology companies hawked their wares while physicians mostly yawned.

The problem: selling doctors expensive, deskbound equipment that required reworking everything they did in their practices, while it likely would not save enough money nor improve efficiency. Even though officials from the president on down talked up the need for health information technology, that wasn't enough to overcome the unfavorable cost-benefit analysis that many physicians saw.

But as both sides are forced to make changes to ensure financial survival, the tech industry and physicians may have reached a point at which technology is finally starting to meet the needs of doctors.

In particular, less expensive mobile technology is allowing some benefits of large-scale electronic medical records without the huge upfront costs, while greater collaboration between companies is moving the emphasis away from the kind of proprietary technologies that don't speak with other systems or struggle to adapt to physicians' needs.

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And as physicians see practice income fall, particularly as fewer patients have insurance, they are growing more open to using that cheaper technology to shave costs.

"It was strictly financial viability issues that forced doctors to get computers in the office," said Alan T. Falkoff, MD. It was the need for viability that inspired many practices to invest in practice-management systems to keep patient data organized and make billing easier. Now viability issues are forcing physicians to invest in clinical IT, said Dr. Falkoff, a family physician in a five-doctor practice in Stamford, Conn.

Evidence of this change in attitudes and strategies was apparent at the 25th annual Towards the Electronic Patient Record Conference, held in Palm Springs, Calif., in February.

When C. Peter Waegemann, founder of Boston-based Medical Records Institute, a research and consultancy organization that organizes the annual conference, held the first TEPR 25 years ago, he had a vision of every doctor having the capability to store and transfer patient records electronically. There have been milestones reached along the way, he said, although most have been good intentions and false starts.

More gains have been made in the past year than in the past several years combined, he said. A big reason for that success is the rise in everyday technologies, such as the Internet and mobile phones, that are being integrated into health care.

The organizers of TEPR "are achieving," said Louis Cornacchia, MD, president and CEO of the online physician community Doctations. "Maybe not what they thought they were achieving, but they are achieving."

In a keynote address, American Medical Association Board of Trustees Chair Joseph M. Heyman, MD, noted that the challenge for doctors is not a "lack of health IT, but rather information management. Health IT is simply a means to an end, not an end unto itself." Dr. Heyman uses an EMR system in his solo ob-gyn practice in Amesbury, Mass.
Change in strategy

When presentations by James Mault, MD, director of products and business development at Microsoft, Roni Zieger, MD, product manager of Google Health, and Adrian Gropper, MD, chief science officer of MedCommons, concluded on the second day of TEPR, the three, at the prompting of the moderator, shared a group hug.

Besides the laughs it drew from the crowd, the hug was noteworthy. The TEPR presentation was on building a personal health information ecosystem and all three spoke of the importance of working with others to make health data more portable.

But while software vendor MedCommons has collaborated with both Microsoft and Google on their respective personal health record platforms, so far Google has declined Microsoft's offer to collaborate. Dr. Zieger later said that although no plans have been announced, Google is in talks with Microsoft about making their PHRs compatible.

Experts are crediting cooperation for moving IT adoption forward as technology companies move away from proprietary systems and focus on ways to make mainstream technologies useful in health care. Mainstream technologies are tools physicians can use with systems they already have, rather than buying new hardware and software that can be used with only one product.

For example, as use of the Internet and cell phones have become ubiquitous, the way people communicate with physicians and other caregivers has changed. Now some technology companies are focusing on how those technologies and interactions work, rather than producing large-scale systems that might interfere.

"It's not just about the EMR anymore," Waegemann said.

The most compelling evidence of this change was in the conference's topics. There was less focus on stand-alone EMR systems, and there was a three-day track revolving solely around mobile health IT.

"Last year, I and another presenter were the only ones talking about mobile technology. Now that's all we're talking about," said Frank Avignone, PhD, director of business and sales development for AllOne Health, which developed a cell phone PHR platform that was unveiled at the 2008 TEPR conference.

Waegemann said the mobile technologies being introduced to health care have too much of an impact to be ignored. "A few years ago if someone said, 'Put your health information on Microsoft,' I would have said, 'You're crazy.' "

In response to the growing interest in mobile health technology, the Medical Records Institute formed a new organization, mHealth Initiative, and is holding mhealth workshops throughout the year. Whether TEPR even will be held next year remains unclear, but the inaugural mHealth Initiative meeting has been set for December, and the organization plans to make it an annual event.

"It's the Googles and Microsofts who will change health care in the next few years. It will not be the HITSPs and HL7s," Waegemann said, referring to the regulatory groups that are developing standards for the health IT industry.

In the past, physicians were keepers of all the patient records. Now patients can monitor and keep track of their own health using the same devices they use for other aspects of their lives. This evolving patient-physician relationship has sparked a renewed interest in the patient-centered medical home concept, of which many of these technologies are a crucial piece.

The medical home concept, as defined by the American Academy of Family Physicians, encourages things such as e-mailing with patients, remote monitoring and patient portals.
Shifting responsibilities

Physicians such as Dr. Falkoff have found that the more responsibilities practices can place on patients using technology, the less time physicians and their staffs are forced to spend on nonreimbursed activities.

There are many technologies small practices can afford as a way of reducing staff time and resources, said Dr. Falkoff, who shares his practice with two other family physicians and two pediatricians.

The practice has adopted such technologies as a kiosk that patients use to check in, freeing up staff. Patient portals can be accessed via the Web so patients can view and print their records, or send e-mails to physicians or staff. Patients even can send a note before an appointment alerting the doctor to the reason for a visit, freeing up time at the front end of the exam.

Beyond economic pressures, there also have been government pressure on practices to adopt health IT. For the first time, physicians are starting to see cooperation -- and money -- from government agencies.

Alan Greene, MD, a pediatrician and clinical professor of pediatrics at Stanford University School of Medicine in California, compared the health care industry with a revolutionary war. There is a realization that the old system is no longer working but it is still in charge.

"We are at about the stage of the declaration of independence in the road to EMRs," said Dr. Greene, who in 1995 pioneered the concept of physician Web sites (www.drgreene.com).