Prevent Health Plan Enrollment Fraud

Critical steps all health plans should take to prevent fraud during enrollment season.

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Varying degrees of detail in patient data can make managing identities difficult, leading to health plan enrollment fraud.

Each year, millions of people will join, switch and leave health plans. Some are following their doctors, some are choosing new employer-provided health plans and some are simply ready for a change. Every aspect of health insurance enrollment depends on personal information, or identity data. Payers need to be able to verify that people who enroll are who they say they are – across all their various insurance coverage options. Unfortunately, there’s alarming growth in criminals taking advantage of the enrollment process through scams - creating fake identities for health benefits. Their intent: commit claims fraud or receive unearned commissions.

Health plans need a data analytics partner with the tools – and the expertise – to stop criminals in their tracks to reduce and eliminate enrollment fraud. Detection and elimination of certain schemes result in new tactics, not less fraud. Payers can’t count on detection alone to safeguard the integrity of their plan's member data. They must protect their plan's enrollment systems from identity theft as well as criminals who create fake identities out of an assortment of sometimes legitimate and stolen information.

But they can fight back. Smart insurers and payers -- teamed with a data analytics partner that specializes in information verification and identity data management – can beat fraudsters at their own fraud game. When payers build in the right detection and alert processes, fraudsters start to stand out – enabling focused follow-up investigations.

To fight enrollment fraud, payers need to quickly confirm that data being submitted by an individual is real and accurate – and that it belongs to the person health plan coverage. Once the information is confirmed, payers can compare it to the eligibility standards for their different health plans. That requires cross-referencing thousands of databases, current and historic, piecing together and verifying multiple data points all at once – a seamless verification function at critical points in health plan's workflow.

Our new white paper details how health plans and payers can spot potential fraud without slowing the enrollment process for new plan members. Download our white paper today to get started with understanding how identity data can prevent this type of health care fraud.

Access White Paper Here


Balancing Cybersecurity and Member Engagement


Health Plan Enrollment Fraud Infographic

White Paper

A Systematic Approach to Combat Healthcare Identity Fraud

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