False billing through identity fraud

 Case Study

 

A nationwide biometric patient authentication system for hospitals

saves one billion Euro

Challenge

Finding a solution that would ensure the identity of approximately 70 million citizens in the correct billing of medical treatments, but also in the correct dispensing of medication.

Approach

When a patient came to a hospital for treatment, he or she first had to enter his or her social security number via a terminal, and then finally confirmed his or her identity by means of biometric palm vein verification.

 

Lesson learned

It is crucial to use the right biometric modality, which in this case has been best realized by palm vein biometrics. Neither the use of fingerprints, nor face recognition or iris recognition would have been sensible or practicable here.

Success model

In numerous meetings, workshops and telephone conferences, the project was planned in detail and successfully brought to success step by step.

 

Patient identity is a very high value that one tries again and again to compromise by falsification. This often leads to extremely high additional costs – for the patient, health insurance companies and health authorities. However, biometrics can also be used differently in this environment: e.g. in the pharmaceutical industry, where the use of biometrics can prevent the misuse of drugs or prescriptions.

In the area of health research, the use of biometrics can ensure that only authorized employees can access selected laboratories and data.

Below is the example of a country that, through the widespread use of biometrics in almost all hospitals, has reduced the annual costs of one billion Euros which was caused by identity fraud in the (false) billing of patient treatments, was almost eliminated.

Challenge

We needed to find a solution that would ensure the identity of approximately 70 million citizens in the correct billing of medical treatments, but also the correct dispensing of medication.

The proof of identity used until then, such as insurance cards (-card), birth certificates (usual copies of them), driver’s licenses, identity cards simply offered too much room for forgery.

At the same time, the solution had to be able to perform biometric identity verification, as well as treatment approval, the associated treatment costs (centralized accounting through the national health insurance system), and their prompt settlement via central government servers.

The implementation of such a project is very complex, time-consuming and different parties have to be involved to realize the solution.

Approach

Every citizen of this country has a social security number. This number was recorded and linked to the individual biometric pattern of the person in question during biometric registration. These data were collected decentrally at local hospitals and stored in highly encrypted form on the government server.

When a patient came to a hospital for treatment, he or she first had to enter his or her social security number via a terminal, and then finally confirmed his or her identity using biometric palm vein verification. After the treatment, the treatment costs were determined, which in return had to be confirmed again by the staff and the patient himself using this method. This initiated the billing process via the government servers, and in most cases, correct billing was possible within 24 hours.

Lessons learned

With the scale of such a biometrics project it is extremely important to define all parties in advance, who ultimately decide what the final solution should look like, what the time schedule should be, who has to provide which budget for implementation and when, and which technical resources have to be used by whom and when. Ultimately, however, a whole lot of marketing and public relations work must be done to justify the necessary investments internally and externally, and users must be convinced that this is a solution that serves sociality, minimizes identity theft and reduces unnecessary costs.

It is also crucial to use the right biometric modality, which in this case has been best realized by palm vein biometrics. Neither the use of fingerprints, nor face recognition or iris recognition would have been sensible or practicable here.

Success model

By using the “right” biometrics, all registered users could be recorded here without any problems. The user acceptance is extremely high, which was ultimately realized by the information that was disseminated in advance via broadband over all media.
In numerous meetings, workshops and telephone conferences, the project was planned in detail and successfully brought to success step by step.
Identity theft/counterfeiting could be reduced to a minimum, thus reducing a high annual cost burden for the state. Even on this scale, the use of biometrics could optimize the “old” processes, reduce costs and achieve high user acceptance.

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