Anthem hack opens multiple inroads to healthcare fraud
Far-reaching impact
The consequences of this hack will not fall solely on the shoulders of Anthem. Fraudsters can use the stolen data to apply for new health plan coverage, just as they can open up fraudulent lines of credit.
"Once you have that kind of data, just like you would open a bank account in that person's name, you could go to Blue Cross Blue Shield or UnitedHealth and become a member of that plan and start submitting fake claims," Patterson said.
As Anthem is the second-largest healthcare insurance company in the country, there is a chance hackers were able to access the personal information of Medicare and Medicaid beneficiaries. Anthem offers Medicare Advantage, Medicaid managed care plans and subsidized insurance.The Department of Health and Human Services Office of Inspector General is investigating whether or not Medicare and Medicaid beneficiaries have been compromised, according to the Associated Press. If so, the potential breadth of fraud using stolen information could be much wider.
The same pay-and-chase model utilized by private insurers is exaggerated with Medicare and Medicaid, Patterson said. As the single-largest insurer in the country, it's much more difficult to proactively flag instances of fraud. Additionally, fraudsters recognize that Medicare covers an older, vulnerable patient population, and phishing schemes and fake phone calls often hone in on senior citizens that may be more likely to provide additional information.
The healthcare industry was already well aware of the importance of cybersecurity. The issue was emphasized in August, when a Community Health Systems breach exposed 4.5 million patient records. Although the Anthem hack is significantly larger, the two breaches have highlighted the real-world concerns of cybersecurity vulnerabilities. Now payers and healthcare providers alike will be forced to try and keep pace with criminals attempting to access medical information.
"Criminals don't have laws or rules, and they don't have a budget. They are always going to be faster they are always going to get there before everyone else does," Patterson said. "That's the challenge: When we see these breaches, to be nimble enough to keep ramping up at an exponentially faster speed so you can stay ahead of the criminals."
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