Stop Healthcare Data Fraud Before It Starts

Why Automated ROI Is Key to Healthcare Privacy

Moxe Health: 08.01.2025 5:34 PM

Cybersecurity Digital ROI release of information

In his mid-year update, our CEO talked about the importance of ensuring that healthcare stakeholders have a privacy-centric interoperability strategy to combat fraudulent Release of Information (ROI) requests. Why the recent focus on this topic?

As fraudsters get smarter, it’s getting harder to differentiate their requests from the real thing. Even trusted payers and requestors are being spoofed, putting patient data and provider reputations at serious risk. To compound the challenge, not only are their schemes getting more sophisticated, but the number of fraudulent requests are growing. Modern phishing schemes require a modern ROI solution.

What is causing the uptick in fraudulent requests?

After recent large data breaches, it is not surprising that there are more fraudsters using legitimate information to gain unauthorized access to patient data. Once data has been compromised it becomes much easier to use real patient names, Medicare numbers, dates of birth, etc., making the phony requests that much harder to spot. What can your team do?

Stop cyberattacks with automated Release of Information

Leveraging a fully automated solution fundamentally eliminates these risks.

Moxe’s automated Release of Information ( ROI) solution uses API-based integration that requires all requestors to use token-based authentication with established credentials making fraudulent requests nearly impossible. When a new requestor is added to Moxe’s digital network their identity is verified, therefore when a request is received electronically from that requestor, providers can be confident that it is not a fraudulent request.

Along with significantly reducing the risk of fraudulent requests by eliminating manual processes, our HIPAA-compliant ROI solution accelerates record delivery, reduces costs, and improves accuracy. Real-time dashboards provide transparency in medical record fulfillment, while our privacy-centric health data exchange ensures only the minimum necessary information is shared.

Having the right experts matters

Moxe’s experts are dedicated, passionate professionals trained to spot fraudulent requests. Fully certified and US-based, our experts stay up to date with the latest resources from HHS, AHIOS, and state-specific resources.

“I am passionate about privacy. I love reviewing statutes and regulations to ensure that Moxe’s solutions are compliant,” says Tabitha Peterson, our ROI Lead. In her position, Tabitha works directly with our customers to offer specialized training focused on spotting fraudulent requests.

Some of her top tips to spot a fraudulent request?

1. Different area codes for phone and fax numbers
2. Fake or outdated company logo
3. Asks for provider’s physical signature
4. No medical condition specified
5. Sender may sign the request using a celebrity name
6. “Patient is under our care” / “Regarding our mutual patient”
7. Asks for last or most recent notes, rather than a specific date of service
8. Will use multiple reasons for requesting record
9. Claims to be urgent and HIPAA compliant
10. Poor grammar and/or punctuation

The importance of collaboration

Taking a partnership approach, we work with our customers to ensure we are aware of the latest phishing schemes and pass that information along and vice versa. Recently, one of our health system customers brought a breach to our attention.

“In this instance, we provided information on how to spot fraudulent requests and guidance on a process they can implement for when they do find a fraudulent request,” shared Peterson.

Considering your options

When evaluating ROI solutions, it is important to ask yourself the question, “How will this solution scale with our business?” As regulations evolve and technology changes, is your ROI solution flexible enough to stand the test of time? Moxe is proud to bring all the stakeholders—payers, providers, and requestors—together to modernize ROI, automating requests.

Check out our security eBrief to get our 6 tips on protecting against cyberattacks.