Fighting fraud with biometrics: Medicare's blind spot?

As most readers know, I'm a bit skeptical that CMS's current anti-fraud efforts--particularly the Recovery Audit Contractor program--can do much to stem the tide of fraud within the Medicare and Medicaid program. 

After all, looking for fraud after it happens is primarily a game of Whack-A-Mole that's unlikely to ever keep pace with the bad guys (and meanwhile, the good guys often suffer as well). Preventing fraud by shutting down questionable DME or home health operations, as CMS plans to focus on now, certainly has its appeal but again, there's probably two bugs in the woodwork for every one you catch.

But what if you could do something to reduce fraud at the point of care, by making sure that the right patient actually got the right services from the right doctor? And you could do that by collecting absolutely unique information from a patient, such as a fingerprint, to make sure that happened? This, to me, makes far more sense. 

One startup that has taken this approach, for example, is Biometric Technologies. The company, based in Florida and Colorado, uses biometric technology to help both insurers and providers prove that care is provided appropriately. It uses biometric data, specifically a fingerprint scan, to verify that a patient actually received a service for which a provider is billing. To hear company exec Scott Kimmel tell it, its Bioclaim system can all but eliminate phantom billing (billing for a patient that was never seen, or for services that weren't rendered), and can also time patients to help avoid upcoding by providers.

Aware of such options, many state governments and coalitions are looking or have already looked into biometric and smart card options to cut fraud in health and public benefit programs. These governments include Puerto Rico, Texas and the New England PARTNERS Project, a joint initiative of the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.

Still, to date it appears that CMS isn't terribly interested in such a solution, as logical as it appears. No doubt, the agency is a bit intimidated by the cost of implementing biometric technology (or requiring providers to implement it), and its leaders may not feel they understand it well enough.

Not only that, implementing fingerprint scans or other biometric options at the point of care would generate high integration costs, without a doubt. You can't go from paper to managing and tracking fingerprint scans without some major development work in between.

That being said, I'm amazed biometrics isn't being taken more seriously by federal planners, particularly given how much they worry about e-prescribing security violations, EMR privacy protections, the need for secure remote monitoring of patients and what have you.  There's clearly something I'm missing here.

Folks, what do you think? Does biometrics make sense as the next wave of Medicare fraud fighting technology? If not, why? I'd love to hear your thoughts. - Anne

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