PUTTING IDENTITY VERIFICATION TO THE TEST: “WILL THE REAL DR. JOHN SMITH PLEASE STAND UP?”
Identity Verification Gap – Gap 5 of the 5 Critical Gaps in Health Care Compliance.
Matching a name to each and every record required for proper screening of a candidate is like putting the pieces of a puzzle together in order to see the big picture of a person or an entity.
When using the online exclusions search service on the Office of Inspector General’s (OIG) website, there is a field for a last name and a first name. The results come up with either a “No results” response, or an exclusion report that allows you to verify with a second page listing the first name, last name, and if available, middle name or initial, date of birth, NPI, UPIN, license type, specialty, address, exclusion type, exclusion date, and waiver information. If there is any slight error in typing the name, or if the applicant is using a name different than the name by which the person was excluded, the search will come up with “No results” indicating a free and clear to continue with the hiring process, when that individual could actually be excluded.
In looking through the downloaded exclusion list available through the OIG’s website, here is one example for the name Mohamed Ahmed as a demonstration of multiples and variations. One Mohamed Ahmed’s middle initial is G, is a pharmacy technician listed as residing in West Orange, NJ; another Mohamed Ahmed’s middle name is Hassan, is a pharmacist with a noted NPI number listed as living in Flushing, NY; another Mohamed Ahmed has no middle initial or name, is owner/operator of a transportation company listed as living in Waupun, WI; and, another Mohamed Ahmed’s middle name is Mohamud, is owner of a transportation company with an address in Columbus, OH. There are seven David Anderson’s, nine Karen Smith’s and thousands of first and last names with two to four of each.
That’s just the OIG’s list of excluded individuals and entities (LEIE). With thousands of disparate data sources such as state medical licensing boards, medical schools, FDA, DEA, Social Security Administration’s Death Master File, FBI, U.S. DOJ, and abuse registries that are used to screen and monitor individuals and entities in the health care field, matching data records to the proper identity is simply impossible without sophisticated technology that automates matching algorithms on millions of aggregated records for failsafe identity verification.
A person’s life is not static. There are times where a shortened version of a first name is used, or a married name assumed and possibly later in time, reverts back to a maiden name. There are unique spellings of common names such as with John and Jon. If the stability of your organization and safety of your patients relies solely on the accuracy of a staff member manually inputting a first and last name into a searchable database, there is great exposure to risk.
When you add into the equation the schemes used by those intending to evade detection, identity verification is a science that requires both technology and highly skilled data analysts to assure a 99.9% match, 99.9% of the time. With Verisys’ data platform of 320 million records run through its proprietary matching algorithms with any possible/probable matches analyzed by its trained staff, you can sleep at night knowing you have eliminated any margin of error in your hiring decisions.
Gap 5 of “Achieving Transparency Through Closing 5 Critical Gaps in Credentialing”, is produced by Verisys Corporation, offering the industry’s leading health care data platform delivering transparency that assures your reputation and the safety of your patients.
The e-book, “Closing the 5 Critical Gaps: A Guide to Understanding the Issues and Using Data Technology to Improve Provider Transparency to Protect Patients and Reduce Risk” is available to download here.
As an NCQA Certified and URAC Accredited Credentials Verification Organization, Verisys handles data reports as a Consumer Reporting Agency abiding by federal law set forth in the Fair Credit Reporting Act. Verisys stores and exchanges data from a Tier 3+ secure environment, assures 99.9% identity verification accuracy 99.9% of the time, and stands by its work with full indemnification.
Verisys operates in compliance with two international quality standards, ISO 9001:2015, certified for quality of credentialing software and background screening; and, ISO 27001, certified for highest standards of information security and data protection.
The sum of these certifications and accreditations ensures that promises made are promises kept to the world’s highest standards.
|Written by Susen Sawatzki Healthcare Industry Expert|
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