The Department of Health and Human Service (HHS) General Accounting Office (GAO) completed a study on the use of smartcards to prevent fraud in Medicare. Their findings were that the use of smartcards would completely or partially prevent 22% of Medicare fraud, which in their minds did not support the cost or inconvenience of implementing a smartcard program. They stated most Medicare fraud (about 68% of the cases) included more than one scheme with 61% including two to four schemes. The most common health care fraud schemes were related to fraudulent billing, such as billing for services that were not provided and billing for services that were not medically necessary. They determined that having a smartcard would not have prevented these types of fraud because the patient was present and did actually receive some type of care.
The question that the HHS GAO study did not consider was patient safety. I realize there is a lot of Medicare fraud, that it is a great burden to our government, reducing the amount of funding available to support the Medicare program, but patient safety is also an important concern. The lack of standards for patient identification at the federal and state levels compromises patient safety and escalates health care costs. According to Healthcare Information and Management Systems Society (HIMSS), 8-14% of Electronic Health Records (EHR) have patient identity errors. The risk of an identity error increases 5% every time a record is shared among providers. Simply said, a physician relying on the wrong EHR and medical history due to an identity error can make a costly, if not deadly, decision. Having a smartcard, especially one paired with a biometric identifier like a pal- vein scan, would provide an absolute patient identity, eliminating the potential for an identity error.
Smartcards have been used in Europe for healthcare identification for over a decade. Smartcards with biometric pairing are starting to be used now in the US for healthcare identification. Medicare fraud should be a prime concern for the Center for Medicare/Medicaid Services, but I think the GAO should consider the impact on patient safety that smartcards could have before dismissing them completely.