Patient Verification vs. Identity Fraud

A recent article in the Healthcare Info Security discusses a study conducted by the Ponemon Institute, sponsored by Experian’s ProtectMyID. The study asserts that nearly 70 percent of the medical ID theft incidents involved others fraudulently using credentials to obtain healthcare services. In more than half of the medical ID theft cases, the victims didn’t report the incidents to law enforcement, often because they knew the person who stole their identity.

This is often called the “Robin Hood effect” because family members are allowing the use of their insurance card to cover uninsured relatives. It is understandable why someone might help out an ailing relative, however, cases have been found where cards were used to purchase medical devices and equipment like scooters that were later sold on eBay.

The Affordable Care Act estimates that healthcare reform could bring coverage to 30 million uninsured who lack coverage. By covering more people with healthcare, we should see a substantial drop in the number of uninsured but will we see a corresponding drop in medical ID theft? That may be optimistic.

That’s because not all health insurance policies are created equal. Some of the least expensive new offerings expected to be obtainable on the market, or provided through the expansion of state-level Medicaid and Children’s Health Insurance Programs, might not offer all the benefits someone wants, Ponemon says. There could still be a motivation to fraudulently gain access to better polices which have more benefits.

One way to deter medical identity fraud is to add advanced technologies like biometrics to insurance cards. The biometrics would be used to verify the identity of the patient at every visit and would prevent fraudulent use of the insurance plan. Biometric identification would also support […]

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    The use of Kanban to support a well defined Software Development Life Cycle

The use of Kanban to support a well defined Software Development Life Cycle

In our last blog I discussed how the Scrum process supported the Software Development Life Cycle. Partnet uses two different proven Agile development methodologies for development: Scrum and Kanban. A specific method is chosen based on the nature of the work.

Scrum: Used for complex projects where increments of work can be flexibly managed and assigned into sprints. Work assigned within a sprint can be completed without disruption.
Kanban: Used for less-complicated projects (e.g., Problem Reports) where priorities frequently change.

Kanban is a backlog-pull model that emphasizes just-in-time delivery of work and avoids process bottlenecks by limiting in-progress work. Kanban also allows for customer-driven prioritization as tasks are regularly prioritized to match their current needs. This means that if an emerging requirement suddenly takes precedence over existing priorities, the team can flexibly respond without affecting project goals or progress. Kanban uses the same Delivery Team roles and responsibilities employed in Partnet’s Scrum process. Partnet employs Kanban for Problem Report work since this work is often subject to shifting priorities.

Partnet’s Kanban process pulls new requirements from a Customer prioritized backlog. Tasks are created and assigned to release versions based on these priorities. The process defines a series of work queues that simultaneously identify the current status of a given development task, and the assigned resource.

Together, the work queues establish a linear workflow for completion of assigned development tasks, as shown below.

 Work Queues and Linear Workflows

Work Queue
Status

    Assigned Resource

To do
Backlog task; not actively being worked on by any project team member
   Backlog

Needs Requirements
Undergoing requirements analysis to define new functional requirements; assess impact to existing functionality
    Requirements Manager

Ready for Development
Requirements analysis complete or not needed

    Developer

Development in Progress
Development and integration underway; includes unit testing and code reviews
  […]

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