Know Your Patient: Helping the Healthcare Sector Mitigate Fraud

Scammers and unethical actors have long targeted the healthcare sector. They often try to steal the sensitive information of patients to carry out medical identity scams or commit insurance. As a result, healthcare organizations need to continue being watchful to guarantee patient data protection. Know Your Patient (KYP), in this regard, helps the healthcare sector safeguard the potential data of patients, eventually reducing the risk of fraud. This article discusses the significance of KYP and how identifying patients can help organizations mitigate the risk of fraud.

What is Know Your Patient (KYP)?

Know Your Patient (KYP) is a derivative terminology of Know Your Customer (KYC). To reduce identity theft, money laundering, or other monetary crimes, financial organizations are directed to authenticate the identity of every customer trying to open an account, whether digitally or physically. Companies must confirm that the client is genuine. With that said, Know Your Patient (KYP) is another practical application of this idea to the healthcare sector. Institutions may leverage this technology of patient verification while onboarding patients.

How does Patient Verification Work?

The general process for Know Your Patient (KYP) is as follows:

Initial Verification

The initial verification process is conducted at the beginning stage of patient onboarding. Patient information is gathered, including name, birth date, and health insurance information. The provided information is verified via verification methods, such as government ID verification or database verification. Initial validation of a patient’s originality is critical in controlling health insurance, medicare fraud, and other scams of medical identity theft. 


When a previously registered patient interacts with a healthcare organization, it is imperative to re-verify their identity. Companies can significantly accomplish this re-verification using the similar Know Your Patient methods to confirm the identity of patients. Nevertheless, in lower-risk circumstances, companies may utilize simple verification methods. For instance, a selfie verification method where patients can capture and upload a selfie, which is then compared to a photo in the existing database. Hence, the re-verification of patients helps healthcare organizations eliminate different medical frauds.

Major Use Cases of Patient Identity Verification Process

The Know Your Patient (KYP) process can be implemented for various purposes. However, some significant use cases are as follows:

Protection of Sensitive Patient Information

All healthcare institutions are guided to protect their patient’s sensitive information. Healthcare organizations are subject to restrictions under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 to ensure the security of all patient data. Hence, it’s the responsibility of institutions to ensure data privacy so that only relevant authorities can access the information. 

Patient verification, as an integral part of the KYP process, can help organizations achieve this goal. For instance, when a patient wants access to its health database via the web portal or application, they can simply log in and check the records. This protects the account from bad actors or attackers.

Digital Patient Onboarding

Conventionally, a patient’s identity verification would occur in the office. In this regard, a patient has to provide certain information, including their name, date, and place of birth, along with their national ID. It helps healthcare businesses to ensure the patient is the one they claim to be.

For current companies working in the digital health horizons, for instance, telehealth providers, patients are digitally onboarded. While registering new patients, their identities are verified digitally. In this regard, smartphone cameras make it relatively easy for patients to capture and upload photos of their IDs, driver’s licenses, or insurance cards. 

Combating Fraud & Medical Identity Theft

When a bad actor gets private information about a patient’s health record, they might manipulate or misuse it to earn specific benefits, such as medical treatments, insurance benefits, etc. However, by verifying patient identity through the Know Your Patient (KYP) process, organizations can play an essential role in combating this challenging form of fraud. Nevertheless, the process just requires uploading the relevant record and cross-verifying it against the existing database.

In A Nutshell

The healthcare industry must take every possible measure to ensure the security of their patient’s data. Know Your Patient (KYP) is a practical solution that helps healthcare organizations reduce the risk of fraud by confirming the identity of patients during the onboarding process. In addition, the institutions may re-verify it whenever necessary. It’s time for the healthcare sector to adopt KYP as a standard practice to ensure patient data privacy and security.

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