Consumers are so used to fraud detection tools outside of healthcare that they are hardly a competitive advantage anymore. Yet within healthcare the options are disconcertingly limited.
Regularly checking your Explanation of Benefits is about the only one, but most people do not even know what to do with EOBs, meaning that consumers are rarely effective in rooting out fraudulent claims, even ones made in their name.
Looking to engage consumers in the fight against abuse and fraud, ID Experts on Thursday unveiled MIDAS, which stands for Medical Identity Alert System, a service that sends SMS text or email alerts to smartphones when a healthcare transaction is submitted so a user can check that in what the company described as plain language and if it looks suspicious, the MIDAS team follows-up, effectively bridging the gap between patients and health plans to investigate whether it is a legitimate claim, or not.
“It’s like a credit monitoring service for PHI,” said Christine Arevalo, vice president, healthcare fraud solutions at ID Experts. “We grab the data by working in partnership with the payer to provide alerts to the consumer.”
Arevalo said that ID Experts intends to divulge working relationships with several payers soon and thus far has announced Moda Health, in Portland, Ore. as a customer.
For ID Experts to deliver on claims of helping take a chunk out of the estimated $80 billion fraud committed annually — and, in so doing, ultimately lower healthcare costs across the board — great scale and a large number of payers will need to participate in the service and educate their members about using it.
Arevalo added that awareness and education are components to MIDAS, and that by making the information simple for consumers to digest, they hope to empower users to take control of their healthcare transactions.
Moda Health, in the meantime, appears to view MIDAS as giving it a competitive edge.
“In the face of consumer choices resulting from healthcare transformation,” Moda CEO Robert Gootee said in a prepared statement, “we feel this distinguishes us by allowing our members more control of their healthcare transactions.”
Arevalo said that ID Experts is working on native apps for iOS and Android that it plans to bring to market in 2014.
