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Fighting fraud with biometrics: Medicare's blind spot?

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CMS
Biometric Technologies
State Governments
Recovery Audit Contractor
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fingerprint scan
Electronic Medical Records (EMRs)


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

Comments

This past summer I went to Sea World San Diego with my family. We decided to buy the season tickets. I was amazed that when we entered the gates for the first time as a season ticket holders, they scanned our thumb prints. It makes sense. Its probably a great deterrent. Anyone who gets scanned is probably a lot less likely to share their season pass with others.

No, it does not make enough sense to initiate this plan. There are, as you mentioned, the cost of the readers, also the training of the personnel, the failures due to lotion on hands, etc and then the infection control issues. These readers, touching the hands of each patient, would have to be adequately disinfected between each patient. Right now, the signature of a patient or caretaker along with the current accreditation movement will provide similar outcomes for reduction of fraud without the increased cost of hardware, training and risk issues. No system will ever be perfect if humans are involved.

I would note that CMS has not received one penny in additional funding for program integrity work since 2003, it is highly unlikely that something like this would be feasible given that Congress will probably not pass any additional funding this year again.

How would this work for a DME company that has no physical contact with the patient?

Better identification of both staff and patients can significantly reduce fraud and medical errors, and ensure patient privacy. Ultimately, biometrics are the best and simplest way to get an accurate ID every time, so this is where our health care system will be going. However, selecting the right biometric is critical to success. Fingerprint technology is primarily useful as a law enforcement tool and has performed poorly in clinical environments, for the reasons mentioned in previous comments and other reasons. Iris identification, using a digital camera that takes a picture of the colored ring in your eye, is more accurate than fingerprints, works while wearing gloves and masks, is sanitary with no physical contact, and doesn't have the "big brother" aspect of fingerprinting. Iris ID systems have been used in expensive airport security and passport control systems for the last 10 years with zero errors. These newer biometric technologies are moving rapidly into healthcare facilities. Earlier this year, for example, Eye Controls released a low-cost clinical iris ID system called SafeMatch that uses the same core technology as the expensive airport systems. Health care ID errors, whether caused by fraud or mistake, cost money and harm patients, and available biometric tools can help solve these problems, make operations more efficient, and protect the privacy of patient records.

I would have to comment that touching a fingerprint sensor isn't going to have any more health concerns than picking up and using the pen that everyone uses to sign in on the clipboard, touching the door handle to enter the doctors office or picking up and reading the magazines in the waiting room.

FACTS:
1) My laptop came with a fingerprint reader and I love the fact that my data is secure and I don't have to constantly remember what my password is.
2) The everyday consumer can buy a USB fingerprint reader for less than $50! So it stands to reason that HealthCare Agencies can use their buying leverage to purchase at even lower prices.
3) I read a story about a woman in California who had 3 babies in one year. Actually she didn’t – but her health insurance paid for 3 births in one year. We are all paying extra for this fraud.

So biometrics offers- convenience, accuracy and fraud reduction (translating to lower prices for the consumer)
Sounds like a “no brainer” to me!

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