HIPAA Compliance and Fraud Prevention — Challenges & Solutions

This article discusses what HIPAA is, who must comply, and specific solutions to HIPAA compliance and fraud prevention requirements.

What Is HIPAA?

HIPAA is the “Health Insurance Portability and Accountability Act”, a U.S. privacy regulation that defines the levels of protection that must be implemented by organizations responsible for managing, distributing, or storing health information. HIPAA applies to organizations in the healthcare industry, including hospitals, clinics, doctor’s offices, health insurance companies, and healthcare clearinghouses.

HIPAA Compliance Requirements

HIPAA specifies the types of healthcare information that are considered private and who that information can be disclosed to. It also specifies administrative, physical, and technical safeguards required for business and information systems that process protected healthcare information.

HIPAA Compliance and Fraud Prevention Challenges

Two HIPAA requirements are particularly challenging for healthcare providers:

• Section 164.302-318, which requires strict controls around the use and disclosure of electronic protected health information (PHI).
• Section 164.306 a1, which requires you to “ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.”

As a healthcare provider, you’re required not only to implement administrative, physical, and technical fraud safeguards that enforce these standards for access and confidentiality, but also to demonstrate your compliance through a rigorous audit process.

These compliance and fraud prevention requirements are challenging for one key reason: Most applications, both legacy and modern, do not include a logging mechanism that provides a complete history of user access to cardholder data. In many cases, logs include only update actions and not user queries and other read-only actions. An audit of all individual user access must include read-only activity in order to be complete.

The Luminet Solution

Luminet fraud monitoring software records user activity in real time—screen by screen, keystroke by keystroke—creating an audit trail directly from the network. This audit trail includes both update and read-only actions for both regular and privileged users.

Luminet stores this information in a secure repository, from which you can conduct powerful full-text searches through current or recorded activity. These searches allow you to visually play back every screen and keystroke relevant to your audit.

Customizable dashboards, graphs, and reports enable your internal auditors to see the big picture at a glance and zero in on activity that puts HIPAA compliance at risk.

Built with Substantial Business Process Functionality

Learn how Luminet detects and prevents fraud in the healthcare industry.