Enrollment and Eligibility a Top Priority at 2012 MESC Medicaid Conference
The expansion of Medicaid as a result of the Affordable Care Act and the push to modernize Medicaid systems and processes focused a lot of attention on enrollment and eligibility at the recent Medicaid Enterprise Systems Conference in Boston. The attendees we spoke with were concerned about whether the federal data services hub will be ready in time for the required deployment of health insurance exchanges in 2014 and how much value government data sources will have in light of the fact that IRS data may be 12-18 months old and won’t include a substantial number of non-filers.
A number of systems integrators and eligibility software vendors were exhibiting and they all stated that they relied upon the states to authenticate each online enrollee. The problem is that many states naively rely upon Social Security Number and date of birth checks to authenticate enrollees in an environment where it is easy to steal someone’s SSN and is also easy to look up someone’s d.o.b. and place of birth on social network sites. Recent statistics bear this out. In 2010, 7.0% of households in the United States, or about 8.6 million households, had at least one member age 12 or older who experienced one or more types of identity theft victimization according to the Bureau of Justice. In 2011, 1.49 million Americans were victims of medical identity theft and studies estimate that the number will increase by 25% in 2011.
Over the past three years, about 21 million patients have had their medical records exposed in data security breaches that were big enough to require they be reported to the federal government. This does not included unreported data breaches of less than 500 records, which may be more common than is thought. Once personal identifiers are exposed to the outside world, they are out there forever which is the reason that social network sites are so risky. The economic impact of medical identity theft is estimated to be $41.3 billion per year.
It makes one wonder how much healthcare coverage and associated medical services for stolen or fraudulent identities will cost the tax payer if the online enrollment and eligibility determinations on public health insurance exchanges result in Medicaid coverage or health insurance premium subsidies for frauds?
States will eventually realize that private, secure sources of data on which to provision knowledge based authentication will substantially reduce the risk of fraudulent enrollment, and more current employment and income information can significantly improve eligibility determinations.
Please contact us for more information about minimizing fraud and data loss, or to speak to a specialist about the best ways to ensure secure access to your data and online services.
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