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Babystep 6: Smartcards and Provider Fraud

Smartcards can detect fraudulent claiming by corrupt providers for services not actually delivered, or the counterfeiting of claims by administrative clerical staff.

Health & welfare smartcards have special potential advantages for combating provider fraud, especially in offline environments where points of service are not connected to central mainframes. There are valuable lessons for health cards arising from the EMV smart credit card program, where abuse of lost and stolen cards is better detected and managed across a wide range of offline settings. Some of the finance sector’s concerns over card abuse translate into the health & welfare sector, and show how to combat provider fraud, over-servicing, prescription shopping and so on.

This paper looks at bogus claiming perpetrated by corrupt providers, clinical administrators and government clerks.