Home' News Bulletin : ADA News Bulletin May 2015 Contents 13
Is your patient and practice
data safe and secure?
PRIVATE HEALTH INSURERS
ARE WATCHING YOU!
Make sure your patient and practice data is safe and secure
the fraudsters, government and private health insurers are
Every year committee members of the Australian Dental
Association (ADA) attend conferences that discuss matters of
importance to the dental profession and dental patients.
pRivAtE hEALthCARE AuStRALiA FRAuD FORum
A recent example is the Private HealthCare Australia (PHA)’s Fraud
Forum (Forum) held in Adelaide in March which was attended by
members of the ADA’s Schedule and Third Party Committee.
PHA is the peak group representing Australia’s private health
insurance (PHI) industry. Consultants and private investigators,
law enforcement representatives from Australia and the United
States, as well as representatives from the banking sector gave
presentations to the Forum. A number of Commonwealth
Government agencies and regulators, namely the Office of
Australian Information Commissioner, Department of Human
Services and the Australian Health Practitioner Regulation Authority
also gave presentations.
The general themes arising from the Forum concerned the
challenging environment in which healthcare service transactions
occur. The ever increasing use of electronic technologies and the
internet, including mobile based applications to store and send
data, has created many opportunities for fraudsters to not only
steal data, but to create fake identities from which health services
can be falsely claimed.
Australia is one of the most internet connected countries in the
world: (89%) compared to the rest of the world (34%); India
(12%) and China (38%). A breach of a computer’s security
takes an average of 230 days before it is detected. In the United
States, the cost of medical fraud is estimated to cost $80-$230
Billion per annum. Medical identity theft has increased by 22% in
2014. Out of all identity theft breaches, 42.5% of breaches were
medical/health related. This is because the market value for stolen
information is much higher for medical information – a medical
file is worth 50 times more than a social security number in the
stolen identities market. We expect the trends to be similar in
DENtAL pRACtiCE pROtOCOLS
At the dental practice level, the Forum highlighted the importance
of having robust systems to secure patient records and
commercially sensitive information. All practices should have clear
protocols in place to regulate not only the safe and secure input,
backup and storage of that data; but also how to respond in the
case of a security breach.
“the ever increasing use of
electronic technologies...has created
many opportunities for fraudsters
to not only steal data, but to
create fake identities...”
One theme members should take special note of is the PHI
industry, as well as government agencies, in particular the
Department of Human Services and Medicare, are developing
sophisticated ways to track and analyse claims made for health
services. Government agencies and departments in particular,
have indicated a willingness to engage with the PHI industry
in information sharing that would assist each other in work on
investigations; whether it comes to situations of outright fraud or
just irregular claiming patterns and discrepancies.
While PHIs and government are required to behave within the
existing privacy laws, the ADA nonetheless finds this developing
cooperation to mean that healthcare services are likely to be
placed under more regular scrutiny in the future by both PHIs and
The ADA has no doubt that the overwhelming majority
of members provide dental care to patients ethically and
professionally. Nonetheless it is in all of our interests to take extra
care in ensuring that treatment provided is in the best interests of
the patient, and that adequate records are made and, now more
importantly than ever, are kept secure. If a third party such as a
government agency or a private health insurer approaches your
surgery or staff for information regarding treatment records of
a patient, you should immediately contact your ADA Branch for
advice and support.
To assist members and new graduates, the ADA is in the process
of considering providing additional specific training in how to use
the Australian Schedule of Dental Services and Glossary (the ADA
Schedule) to code and record treatment provided to patients.
Watch this space.
Senior Policy Officer
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