Moda Health turns to automated fraud prevention to help protect members

Real-time feedback allows beneficiaries to monitor their claims and prevent identity theft
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Moda HealthAs insurers look for ways to fight healthcare fraud and identity theft, one insurance company is turning to automated alert system to offer real-time identity theft monitoring and fraud resolution for its beneficiaries.

This month, Moda Health, an insurer based in Portland, Oregon, announced that it would be incorporating the MIDAS Alert system, developed by ID Experts, into its plans as a way to help members identify false claims. The built-in, automated alert system provides text or email notifications any time a new claim is submitted under a beneficiary's name. If there is a suspicion of fraud, ID Experts will investigate the concern.

In an exclusive interview with FierceHealthPayer: AntiFraud, Katie Paullin, director of marketing for Moda Health, talked about the reason the insurance company opted to provide this option to its members and how the new tool will limit cases of identity theft.

FierceHealthPayer: Antifraud: Why did Moda Health decide include the option for built-in medical identity fraud prevention into insurance plans?

Katie Paullin: I think we all understand that, as electronic health records (EHRs) become more standard in healthcare, there is chance for fraud to happen. At Moda, we're committed to protecting the health and well-being of our members, and offering this just seemed like a natural way for us to continue our charge and our mission to help our members be better.

FHP AF: Was there something that stood about MIDAS in particular?

Paullin: We all know identity theft happens, and we've seen breaches. I think ID Experts is one of the first companies going out and looking to see how the changes to EHRs might affect our personal health, and making sure it builds a product that will solve that. ID Experts has been out in front solving this problem from the beginning.

FHP AF: In what ways does this make it easier to keep track of fraudulent activity or identity theft?

Paullin: Our Moda members are offered this product and they choose to sign up. It's all through an online interchange, either on your phone or your desktop. As soon as MIDAS gets an alert that something has happened on that member's health record, it sends something out to the member.

I think this does a couple different things: It's making sure the member sees it in real time, and it's helping them define what that means in terms of coding. We all know we use medical codes, so MIDAS breaks that down for them to understand. It's just a nice, easy way, with an intuitive user interface, for people to see this is where it says I went, this is what happened when I went there, and is that true or not true?  If it's true, then I'm good. If it's not true, MIDAS will research it for us and protect the member.

It makes it a really simple user interface, highlighting in real-time what is going on, so people can stay on top of their health the same way we all stay on top of our bank and financial information.