Employers protecting employees & bottom line

Health-Care Fraud and 'PHI'

By Rebecca S. Busch, RN, MBA, CFE, CCM, CBM, FHFMA

Your employees' "protected health information" - names and addresses, social security numbers, payment histories, diagnoses - can be stolen or misused. Learn how your entity can protect its employees and add to the bottom line. 

Betty, a longtime administrative assistant at ABC Foods Inc., a large conglomerate, was hurting. She had recently fallen on the steps outside the company's headquarters and had broken her ankle.

Shortly after her accident, the company's health-care provider asked Betty to sign an extensive treatment contract that was in direct conflict with the employers' benefits' contract that the employer had signed via its insurance company. Employees, including Betty, rarely know anything about employer and insurance company contracts. Regardless, she quickly signed the treatment contract but didn't notice a clause that said she had to pay the provider even if she didn't receive her full treatment or if it wasn't effective. Betty never received all the provider services but nevertheless the provider submitted a claim to the carrier for payment in full. The provider pursued a higher rate of reimbursement contract with the employee knowing that it already had one with the insurance company at a lower rate.

In the meantime, Sam, who worked in the human resources department of ABC Foods, had sold Betty's name, address, date of birth, and social security number to a crime ring that set up a false line of credit. But more importantly, Betty's information now could be used by any of the "players" in the health-care system to bill for services or supplies that weren't provided.1  

How can employers help their employees avoid becoming the victims of health-care fraud and medical errors? By concentrating on the employees' protected health information (PHI) and the U.S. Health Portability Act of 1996 (HIPAA) that protects it.

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