The DNA of Healthcare

Visit Corporate Site

How to Keep Open Enrollment from Becoming Open Season on Identity Theft

Healthcare Identity Theft
Senior Director Healthcare Strategy

After the open enrollment period begins for your plan, you may be excited to see the number of new enrollees rolling in. However, chances are that hidden within the wave of enrollees are some new members who are not who they say they are.

It’s an unfortunate reality. Enrollment fraud remains a major challenge for payers. It is an ongoing issue any time of the year, but the stakes are higher during open enrollment. Bad actors know their best chances of slipping in unnoticed is when plans handle a greater number of new enrollees in a short amount of time.

Many new enrollees include people who move, switch doctors or have a new employee health plan. These are all legitimate reasons for enrolling in a new health plan. But how do you verify all these new members are who they say they are? 

Due Data Diligence

The goal is to stay one step ahead of the bad actors, to prevent this type of activity without interrupting the user experience. And it’s better to act in advance than try to recoup money lost through fraudulent enrollments.

Verified identity data is key. It’s part of smart technology that helps you spot potentially phony or inconsistent identity data at or before enrollment. This can be your most powerful defense against enrollment season identity theft.

 A completely fictional enrollee might be easier to flag than a new enrollee with a mix of real and fake information. So, criminals might use a legitimate name with a fake address or vice versa. The name bad actors try could be a deceased person, a minor, or someone who is not eligible for enrollment, for example.

But beware, these are not their only tricks. Others you should watch for are outlined in an updated e-book on health plan identity theft discussing “Are your new enrollees who they say they are? How to minimize identity theft during enrollment season.”

Verify Identity Intelligently

It can be difficult to fight off the bad actors on your own, especially during your busiest time of year. They know that. So payers need a data analytics partner with the tools and expertise to stop bad actors in their tracks. They can help you set up early alerts and make dishonest enrollees stand out so it’s easier to root them out of your new member lists.
Look for a partner that can authenticate enrollee identities quickly using verified databases. They should be able to compare data elements against a vast store of data from public records, privately sourced data repositories and government lists.
What are some of the costly dangers if fraudulent enrollees come on board?

  • You overpay for claims made by fraudulent parties
  • You’re liable for fines under the False Claims Act
  • You have to return premium payments

And when bad actors get away with these nefarious activities, they often grow bolder. Breaches of health data are becoming so large and common that experts now just assume bad actors have the data they need. The key now is to prevent them from using it.

To learn more about strategies to reduce enrollment identity theft, download today!

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

Related Articles

healthcare digital identity strategy

Four Pillars of Digital Identity Strategy

The following four pillars of digital identity show why you should align your strategy to include them. Each pillar brings its own value but with a holistic approach, digital identity is a powerful component of a strong defense strategy.

Read More
These blogs are published for information purposes only and can be statements of opinion. Although we LexisNexis rigorously check the accuracy of all information at the time of publishing the blogs, no representations or warranties are expressed or implied as to the blog, its contents and any accompanying materials and it should not be relied upon for acting in specific circumstances. Although links to external websites on any blog posts are tested and deemed accurate at the time of the blog posting, we LexisNexis accept no liability for such links to external websites and do not endorse or warrant in any way any materials available through such links or any privacy or other practices of such sites. In addition to this blog disclaimer, access and use of the blogs is governed by the LexisNexis website.