Healthcare organizations and providers are coming under increased threat that inside access to patient health records, controlled pharmaceuticals or billing systems will result in theft or fraud. To confront this increasing risk, much of the focus has been on cyber monitoring and increased background checks. While addressing both has a part in reducing the risk, there remains a significant gap that is unaddressed. ClearForce is unique in its approach to close this gap by providing continuous behavioral monitoring supported by a legally complaint workflow.

The Risk

1. Healthcare records alone are becoming a highly lucrative target for theft. A 2015 data security Insider Threat report, indicated that healthcare data has become highly desirable to bad actors. Healthcare records sell for tens to hundreds of dollars and are now more valuable than credit card information that sell on the black market for 50 cents or less. The enormous detail available in patient records make it possible for criminals to not only apply for credit cards or loans, but to generate large profit and gain from fraudulent medical charges.
2. In addition to healthcare records being sold on the dark web or used to commit fraud, healthcare organizations are seeing an increase in the theft of medical supplies, namely controlled drugs being sold for cash. Doctors and pharmacists with an intent to commit fraud or theft can steal medication by forging prescriptions or placing phony orders. Nurses with an intent to prosper through illicit activity may “pocket” pills, giving the patient less than the prescribed amount while keeping the remaining pills for personal gain. In the most egregious cases, health care providers steal powerful narcotics by tampering with vials and syringes, potentially exposing themselves and other patients to infectious diseases.

3. Fraud, a crime that is not unique to the healthcare industry, is also an issue and is driven by the complexity of the medical billing system between providers and payers. The use of third party clearinghouses to support the coding, approval and billing process significantly opens the opportunity for insiders falsifying billing records.

The Solution

For the most part, healthcare employees don’t decide to suddenly, one day, commit crime in the workplace. Rather, the decision by an employee to engage in illicit behavior is contemplated over a period of time and there are usually leading behavioral indicators. Whether driven by emotional, financial or legal needs, employees often look for ways to address these stressors, and the complexity of the medical workplace and environment offers an opportunity. ClearForce continually monitors key behavioral indicators and through customized triggers can proactively alert organizations to those individuals who have either violated the law, or have started down a financial path that they likely cannot recover from. Additionally, ClearForce centralizes and automates peer, self and whistleblower reports, as well as other internal cyber monitoring alerts that may be in use today.

ClearForce operates with full employee consent, removes judgmental bias through standard job level policy, automates required checks & balances, and provides appropriate levels of anonymity, privacy and security. This industry leading legally compliant workflow supports not only the individual’s rights, it further protects organizations from lawsuits and legal challenges going forward. Healthcare organizations are coming under increasing pressure and civil liability to protect themselves and their patients from all aspects of insider risk. ClearForce can provide both real-time alerting and compliant, automated workflow to protect an organization and its workforce today.