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Cloud helps stop healthcare fraud

JOHANNESBURG – World-class technology, developed by two South African companies, is changing the face of medical schemes in Namibia. Identity confirmation supported by biometric signatures, operated from a cloud-based platform, now enable health care providers to immediately verify the identity of the patient under treatment. In a move to strengthen administrative flexibility and security, three leading Namibian medical aid funds, Namibia Health Plan (NHP), Nammed and Renaissance Health, contracted LifePoint and Muvoni Biometric & Smartcard Solutions (MBSS) for a practical solution to prevent fraudulent claims. To determine a way forward for medical aid funds and to provide them with a single synchronised data platfrom, and integrated approach was developed, including three key pillars determining identity, verification and reliable data access. Health practitioners are supplied with point-of-care and point-of-sale devices, fitted with biometric fingerprint capability as support for immediate verification. This is linked to a cloud-based platform for member enrolment and identity verification. The process is driven by one system that integrates the medical schemes’ administrative systems, payment systems and clinical practice management systems across healthcare providers around Namibia. LifePoint said recently although it is in the early stages of full implementation, the results have the potential to be impressive. Since members are correctly identified and benefits are verified prior to consultation, the risk of bad debts is mitigated. In terms of cost, the new verification system enables the three medical aid funds to prevent losses due to fraud. This implicitly avoids unforeseen administrative costs, enabling the funds to focus on competitive models instead of chasing fraudsters. LifePoint said that access to secure, up-to-date data gives funds the edge in being able to review the outcome of processes and reduce errors. Despite considerable experience in designing complex, integrated biometric systems, MBSS’ Managing Director, Stan Khan, said that developing a centralised database is always challenging. “In this case, members’ fingerprints were linked to existing membership cards. Further growth will be managed in the normal course of on-boarding a member.” In partnership with Fides Cloud Services and LifePoint, MBSS provided all the hardware and software, as well as the cloud-based platform for member enrolment and identity verification.
“Given the soaring costs of healthcare fraud, integrated biometric systems are the way to go in the future. They’re becoming increasingly popular among medical schemes locally and globally. They can easily be applied to banks and insurance companies, which are also battling the consequences of fraud,” added Khan.

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