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MRA Thought of the Day–Release of Information (ROI) Discrepancies: Fraud or a Registration Error?

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Kathy Gordon, RHIA, Vice President of Release of Information

Kathy Gordon, RHIA, Vice President of Release of Information

An attorney requested a complete copy of his client’s medical record. The chart contained two inpatient admissions; one from February in 2009 and the other from May in 2010. The patient expired but not while he was in the hospital. The patient female viagra no prescription who was treated in 2009 died prior to 2010. Is this a medical fraud / identity theft attempt or simple registration error?

Here are my thoughts…

  • The patient’s name, date of birth and medical record number were identical in both admissions. However, it was not possible for the patient treated in 2010 to be the same person as the one treated in 2009.
  • This type of situation reinforces how important it is for ROI personnel to carefully review every request they process.
  • In addition to determining the information to be released, your staff must pay close attention to details:

– Are there differences in the patient’s signature?
– Are there any significant differences (other than patient demographics) that may indicate the health information is for a different individual?
– Are dates of service overlapping or incompatible?
– Is it fraud or a simple registration error?

The ROI function can never be performed based on the assumption that everything was done correctly and is on the up-and-up. In an era of growing medical identity theft and fraud, the request and the medical record must both be carefully examined each and every time.

MRA recommends a page by page review prior to release of any patient information. In this particular situation medical identity theft is considered since the patient’s identity was not properly verified during registration; it should or could have been prevented at the time of registration. But you can never be too sure. Check early and check often.

What are your thoughts?

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