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Biometrics and medical fraud

The South African healthcare industry is made up of a range of services from basic primary healthcare service to high tech premium healthcare services. The basic service is supplied by government free to all citizens.

Needless to say the state service is highly stretched and under-resourced in places as it accommodates up to 80% of the population. The premium healthcare service is offered by private medical aid scheme companies to middle to high income earners at a cost. There is constant pressure from all parties to close the disparity of this two-tiered system.

The private sector is pressurised to be more competitive in pricing. Through the use of biometrics, factors that drive up costs can be combated. The private healthcare sector is currently under pressure from the government to become more accessible to more of the population. This would mean either reducing the benefits to existing clients or reduce operating costs.

A major cost driver for funders is fraudulent claims. These claims are being driven by the patient and the provider colluding or either party acting independently. This however can be drastically reduced if not eliminated with the implementation of biometrics by verifying that the correct patient is being seen by the provider according to the details registered on the system.

It is not unheard of for family members to use another member’s medical aid card when visiting the doctor or alternatively for the doctor to see patients when their funds are depleted and then process the claim in the new year once it is replenished.

These types of activities affect the financial position of the fund which will in turn have to increase membership fees the following year.

The government is also piloting several sites in preparation for the National Health Insurance (NHI). The ability to accurately identify patients will play a key role in the NHI to ensure the correct patient receives the correct treatment based on their history.

The ability to accurately identify patients in an emergency is another point where biometrics can play an important part. It is easy to manage a patient when the patient is conscious in a controlled environment, but in the case of paramedics treating accident victims on the side of the road or a pressurised emergency room it is a whole different scenario.

In a serious emergency the patient is not always able to respond to questions, the lack of information could lead to the wrong treatment and ultimately serious health complications. When a patient's information is implemented with the use of biometric by the match of a fingerprint the patient’s medical history can be accessed.

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