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More on the “Red Flag” Rules

[Staff Reporters]

According to MedicalNews, Inc and Lynne Jeter, the Medicare “Red-Flag” rules are set to take affect on May 1, 2009.

Three Categories

And, according to David Williams, CPA, FHFMA, a healthcare partner for HORNE in Jackson, Mississippi, the Red Flag guidelines for hospitals, clinics and medical practices can be broken down into three categories.

1. Red Flags that definitely apply to healthcare:

• Documents provided for identification appear altered or forged.
• Photographs or a physical description on file are not consistent with the appearance of the patient.
• Other inconsistent information identifies the patient.
• Inconsistent signatures are on file.
• Patient forms or applications appear forged, altered, or destroyed and re-assembled.

2. Red Flags that may apply to healthcare:

• Statements sent to the patient – or guarantor – that is returned as un-deliverable despite ongoing transactions on active records.

3. Red Flags that most likely do not apply to healthcare:

• A fraud alert is included with a consumer report.
• A consumer reporting agency provides notice of a credit freeze in response to a request for a consumer report, a notice of address discrepancy, and/or unusual credit activity.
• Financial institutions and creditors use challenge questions that the person opening the covered account cannot answer with readily available information.
• A request is made for new, additional or replacement cards or the addition of authorized users on the account shortly after a change of address request.
• A new revolving credit account is used in a manner commonly associated with known patterns of fraud patterns.
• The use of a covered account is inconsistent with established patterns of activity on the account.
• There is unexplained usage of a covered account that has been inactive for a reasonably lengthy period of time.

Assessment

Link: http://www.medicalnewsinc.com/news.php?viewStory=222

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Filed under: Career Development, Healthcare Finance, iMBA, Inc., Practice Management, Risk Management, Sponsors | Tagged: clinics, CMS, David Williams, HIPAA, HORNE, hospitals, identity theft, medical practices, medicare, medicare red flags, Patriot Act, red flags, Sarbanes-Oxley | 8 Comments »