Fraud is one of the most pernicious issues facing healthcare today.
It exists in virtually every segment of the industry, contributing significantly to care delivery costs and inefficiencies. These fraudulent activities occur in a number of different ways, including the alteration and/or deletion of healthcare records, changes made to other electronic documents and the creation of fraudulent electronic files.
Amid a U.S. healthcare system rife with complexity and fragmentation, fraud prevention strategies have received increased attention in recent years. This has led to greater recognition of the fact that in order to mitigate fraud risk, a more secure system that can deter either outside (cyberattacks) or inside (employee) tampering needs to be devised.
This is why many within the industry are turning to blockchain-based solutions and their promise of a cryptographically secure, distributed ledger approach to stamping out fraudulent activity. One thought leader at the focal point of new discoveries in this area is David Houlding, the director of healthcare privacy and security for Intel's Health and Life Sciences (HLS) Group.
With nearly 25 years of experience in healthcare, privacy, security and compliance, Houlding oversees the company's blockchain and security initiatives worldwide, including the Intel Healthcare Security Readiness Program , a global collaborative with over 187 HLS organizations across nine countries, including over 40 partners working to scale the program globally.
"At Intel, we see blockchain [technology] as a foundational technology that, in the near term, is going to add compelling value in terms of improving quality of care and reducing the cost of healthcare," Houlding said, in an interview with Distributed.com . "Anti-fraud is a fantastic cost reduction value proposition tied to some really revolutionary new things happening around [blockchains]."
Houlding cited a number of different types of fraud that exist in healthcare, including prescription fraud, medical claims fraud, financial fraud and occupational fraud.
"Blockchain [technology] has some things that can really help with addressing these problems," he said. "When used as a middleware approach within a network of healthcare organizations, if there is any attempt to alter or delete a block once it's written on the chain, it's very easy to detect that. So, changes would be rejected and wouldn't propagate, blocking the alteration or deletion of information."
Houlding added that this can include off-blockchain information as well.
"Blockchain [technology] can effectively prevent the alteration or deletion of information and accounting systems on off-chain electronic documents," he said. "This is because one of the things you can do with blockchain [technology] is store metadata, a pointer and a hash code of off-chain data on the blockchain. This makes it possible to check the integrity of that file to make sure it hadn't been muddled with."
Finally, in terms of mitigating the creation of fraudulent electronic files, Houlding said that a blockchain can help with that as well. Once those files are created and an entry is made on the blockchain, because this information is shared in near real time with different organizations across the network, there's much better transparency. As a result, there's a much better early detection mechanism for fraudulent files than in a system that has silos, where fraudulent files can be created and buried.
"Only someone who has direct access to that silo might have a chance of discovering that fraudulent new electronic file," Houlding said. "If you are posting that kind of stuff on a blockchain that has access to a variety of organizations across a network in near real time, your ability to detect new fraudulent files and effectively block that fraud is greatly enhanced."
According to Houlding, there are a variety of different blockchain stacks out there that support these sorts of applications.
"Obviously there is Ethereum," he said. "Then there's Hyperledger Sawtooth, an open-source blockchain software that's quite popular with Intel, because it was started at Intel and is still actively contributed to by Intel. Finally, there's [the] Coco Framework, which is being led by Microsoft along with Intel collaboration."
Houlding noted that both Hyperledger Sawtooth and the Coco Framework can run on top of a hardware-enhanced security software called Intel Software Guard Extensions (SGX) that can essentially protect the core code data blockchain nodes of these two applications.
"From Intel's standpoint, we want all blockchains to run well on Intel hardware," Houlding said. "So we are very interested in seeing blockchain [technology] be successful because it's a foundational layer that we think is going to pave the way for all kinds of new functionality, including fraud prevention in healthcare."