Red Flag Policy
I. Identify red flags.
- A bill for another individual
- A bill for a product or service that the patient denies receiving
- A bill from a health care provider that the patient never patronized
- A notice of insurance benefits (or explanation of benefits) for health care services never received.
- Driver’s license or other photo ID
- Utility bills or other correspondence showing current residence if the photo ID does not show the patient’s current address. If the patient is a minor, the patient’s parent or guardian should bring the information listed above.
- The photograph on a driver’s license or other photo ID submitted by the patient does not resemble the patient.
- The patient submits a driver’s license, insurance card, or other identifying information that appears to be altered or forged.
- Information on one form of identification the patient submitted is inconsistent with information on another form of identification or with information already in the practice’s records.
- An address or telephone number is discovered to be incorrect, non-existent or fictitious.
- The patient fails to provide identifying information or documents.
- The patient’s signature does not match a signature in the practice’s records.
- The Social Security number or other identifying information the patient provided is the same as identifying information in the practice’s records provided by another individual, or the Social Security number is invalid.
III. Respond to Red Flags.
If an employee of Centra, PC detects fraudulent activity or if a patent claims to be a victim of identity theft, Centra, PC will respond to and investigate the situation. If the fraudulent activity involves protected health information (PHI) covered under the HIPAA security standards, Centra, PC will also apply its existing HIPAA security policies and procedures to the response.
- Cancel the transaction
- Notify appropriate law enforcement;
- Notify the affected patient
- Notify affected physician(s); and
- Assess impact to practice.