5 dangers of poor identity veridication in hospitals

Healthcare Fraud: 5 Dangers of Poor Identity Verification in Hospitals   

Healthcare fraud remains a pervasive issue that impacts hospitals and patients alike. The advent of sophisticated technology and digital records has introduced new vulnerabilities, making it easier for fraudsters to exploit gaps in security systems.

Poor identity verification processes not only facilitate these fraudulent activities but also place patient safety and hospital finances at substantial risk.

Healthcare providers must understand the various forms of fraud and the associated dangers of inadequate identity verification; internal and external factors can wreak havoc on the system, leading to severe consequences beyond financial loss.

This comprehensive blog about healthcare fraud will shed light on these dangers and propose effective solutions to mitigate the risks. Let’s get started!

Industry Problem   

Hospitals face significant risks from both insider and outsider fraud. Insider fraud occurs when medical staff misuse access to patient information for personal gain. This misuse of access can lead to various fraudulent activities, including filing false claims and committing identity theft.

On the other hand, outsider fraud involves individuals posing as patients to access medical services, leading to financial losses and erroneous medical records.

These fraudulent activities highlight the critical need for robust identity verification systems to protect sensitive information and ensure the integrity of healthcare services. Addressing these vulnerabilities is essential to safeguard both patients and their data.

5 Dangers of Poor Identity Verification   

Identity verification should be a top priority for hospitals and other healthcare providers. Misidentification (or the lack of it) is not just a mere shortcoming that should be accepted.

There are a lot of repercussions; both can be life-changing to victims and the institution. Here are the dangers of poor identity verification:

1. Wrong Patient Surgery 

One of the most severe consequences of poor identity verification is wrong patient surgery. This occurs when a patient undergoes a surgical procedure intended for another individual due to misidentification. Such errors can have catastrophic outcomes, including unnecessary surgeries, incorrect treatments, and even death.

The Agency for Healthcare Research and Quality (AHRQ) highlights that wrong patient surgeries often result from lapses in verifying patient identity at multiple points during care.

These mistakes endanger patient lives and result in significant legal and financial repercussions for healthcare institutions. Ensuring accurate patient identification is vital to prevent such errors and maintain trust in healthcare services.

Hospitals must implement stringent verification protocols at every stage of patient care to mitigate the risk of wrong patient surgery. This includes verifying patient identity multiple times, using wristbands with barcodes that can be scanned to confirm identity, and employing biometric verification methods. Training staff to follow these protocols diligently will also aid in reducing the incidence of such errors.

2. False Claims 

False claims are another significant risk associated with poor identity verification. Insiders can exploit inadequate verification processes for financial gain by using stolen identities to file fraudulent claims.

There have been documented instances where poor identity verification in hospitals led to significant fraud and adverse outcomes. For example, a case in Florida involved a hospital employee and an accomplice using stolen Social Security numbers and other personal information from patients to file fraudulent tax refunds.

The employee, Shalamar Major, was a scheduler at Boca Raton Regional Hospital and had access to sensitive patient information, which she provided to her accomplice, Tanisha Wright.

They used this information to claim tax refunds illegally by filing them online, resulting in substantial financial losses and legal consequences for both individuals.

3. Medical Identity Theft 

Medical identity theft is a growing concern in the healthcare industry. This type of fraud occurs when someone uses another person’s medical information to receive healthcare services.

Evelyn Miller experienced this firsthand. She received a text from Atlanta-based Emory University Hospital’s emergency department informing her of an estimated wait time. This puzzled her since she no longer lived in Atlanta and hadn’t used that hospital system in years. Assuming it was spam, she ignored it.

However, a call from an Emory staffer the next day discussing diagnostic results from her ER visit made her realize something was seriously wrong — someone else had registered under her name without proper identity verification.

Although the name and birthdate the hospital had on record were correct, the address was not. Now residing in Blairsville, Georgia, Miller realized the severity of the situation when she received a $3,600 bill from Emory. After a frustrating conversation with the billing department, she wrote to the hospital’s privacy officer, suspecting fraudulent use of her information.

The victim has a background as a retired healthcare administrator, and she quickly identified the potential misuse of her information. However, many victims remain unaware until significant damage occurs, such as collection notices or credit issues.

This is a widespread issue nationwide. In 2022, the Federal Trade Commission received 27,821 reports of medical identity theft.

4. Insider Data Breach 

Insider data breaches pose a significant threat to patient information security. Such breaches occur when employees misuse their access to patient data, leading to the theft and misuse of sensitive information.

One great example is the cybersecurity crime committed by staff at Montefiore Medical Center. The hospital faced a $4.75 million settlement after an employee sold patient data to criminals. The breach, uncovered in 2015, involved stealing information from over 12,500 patients.

The staff sold patient information to an identity theft ring, including names, addresses, Social Security numbers, and health insurance details. Montefiore reported the breach to the Office for Civil Rights (OCR), prompting the Department of Health and Human Services (HHS) to notify the healthcare system on November 23, 2015, of an investigation into its HIPAA compliance.

5. Regulatory & Compliance Violation (HIPAA) 

The cases presented in this blog are just a few examples of violations of HIPAA (Health Insurance Portability and Accountability Act) regulations due to poor identity verification.

Such violations highlight the need for hospitals to implement strict compliance measures to protect patient information and avoid hefty penalties.

Industry Solution: Identity Verification & Risk Assessment Tools   

Implementing robust identity verification and risk assessment tools is crucial towards preventing healthcare fraud.

These tools help ensure that only authorized individuals access sensitive information and services. Here are some effective solutions offered by Searchbug:

1. SSN and Name Match API 

The SSN and Name Match API verifies Social Security numbers and matches them with names to ensure the accuracy of patient identity. It helps prevent the misuse of SSNs for fraudulent purposes. By cross-referencing full or partial SSNs with the patients name, hospitals can detect inconsistencies and prevent fraudulent activities before they occur.

2. Advanced Person Search API 

The Advanced Person Search API is a tool that provides comprehensive background information by aggregating data from various sources. It verifies addresses, phone numbers, date of birth, and other identifying details, enhancing the accuracy of patient information.

This API is particularly useful in detecting fraudulent identities by ensuring all pieces of a person’s profile match up correctly. Results from the best databases often include a full name, aliases, current and previous addresses, all known phone numbers and their types (wireless or landline), date of birth, date of death if deceased, and relative names.

3. Enhanced People Search API 

The Enhanced People Search API offers the same data as the Advanced Person Search API but allows searching for or by SSN details. This feature requires users to have the Restricted Access Add-On (RA) on top of the standard account.

This advanced capability ensures even more thorough verification processes, which are crucial for high-stakes environments where accurate identity verification is imperative.

4. Criminal Records API 

This API checks criminal records to ensure that healthcare employees and other individuals do not pose a risk. It aids in the background screening, ensuring that staff members are trustworthy.

Implementing this tool can prevent individuals with a history of fraud or other criminal activities from gaining access to sensitive patient information. Each of these tools plays a crucial role in maintaining the security and integrity of healthcare services.

By leveraging these advanced verification and risk assessment solutions, hospitals can significantly reduce the risk of fraud and protect their patients’ sensitive information.

Lastly, regularly updating these systems and staying informed about new threats and technologies can further enhance the effectiveness of these measures.


Poor identity verification in hospitals poses significant risks, including wrong patient surgeries, false claims, medical identity theft, insider data breaches, and regulatory violations. By adopting these measures, hospitals can protect their patients, comply with regulations, and prevent fraud and misuse of sensitive information.

The healthcare industry must prioritize identity verification to ensure patient safety, financial stability, and regulatory compliance. Only through rigorous verification processes and continuous monitoring can hospitals mitigate the risks associated with healthcare fraud and maintain trust in their services.

To help hospitals and healthcare providers improve identity verification for their staff and patients, Searchbug offers you the opportunity to test the APIs for FREE.

Try out these identity verification and risk assessment tools without any obligation — there are no fees or catches. Chat with a representative today to inquire about our free API testing.