CONFIDENTIAL

GenKey ClaimSync

Better Healthcare through Technology

29th of June, 2015

2nd Annual Southeast Asia Healthcare Summit

Arnd Langguth, Director Sales & Business Development

CONFIDENTIAL 2

About Genkey

Solutions to prevent Identity Fraud with a focus on Emerging Economies

• National Election solutions (e.g. Ghana, Cameroon, Mozambique)

• Large-scale Health applications (e.g. NHIA Ghana)

• The core of Genkey is spin-off out of Philips®

• Solutions based on own technology and R&D

Fraud in public+private Healthcare

• Patient induced - Impersonation, “sharing” an insurance - Selling prescribed medication

• Provider induced - Claiming w/o having seen the patient - Overbilling

• Fraud induced within the payer system

- Ghost patients

- Sale of medication (esp. from donor’s programs)

3

First Visit Insur No Sex Age G-DRG ICD 10 Diagnosis

2-Apr-13 71923004 F 29 OPDC06A A09 OTHER GASTROENTERITIS AND COLITIS

2-Apr-13 71923004 F 29 ZOOM02A T63.0 ANIMAL BITES >12YRS

4-Apr-13 71923004 F 29 OPDC06A D50. IRON DEFICIENCY ANAEMIA

4-Apr-13 71923004 F 29 OPDC06A K27 PEPTIC ULCER

5-Apr-13 71923004 F 29 OPDC02A ---- ANC

5-Apr-13 71923004 F 29 OPDC06A L23.9 OTHER ALLERGIC SKIN DISEASES

5-Apr-13 71923004 F 29 OPDC06A D50. IRON DEFICIENCY ANAEMIA

6-Apr-13 71923004 F 29 OPDC06A K27 PEPTIC ULCER

10-Apr-13 71923004 F 29 OPDC06A B54 MALARIA

14-Apr-13 15-Apr-13 71923004 F 29 OBGY33A - SPONTANEOUS VAGINAL DELIVERY

15-Apr-13 19-Apr-13 71923004 F 29 OBGY32A O62.9 DYSFUNCTIONAL LABOUR

15-Apr-13 71923004 F 29 OPDC06A .. ALLERGIC CONJUCTIVITIS

15-Apr-13 71923004 F 29 OPDC06A T14.3. STRAINS OF MUSCLE, LIGAMENTS AND TENDONS

15-Apr-13 71923004 F 29 OPDC06A A09 OTHER GASTROENTERITIS AND COLITIS

15-Apr-13 71923004 F 29 OPDC06A - MALARIA IN PREGNANCY

16-Apr-13 71923004 F 29 ZOOM02A I67.9 CEREBROVASCULAR ACCIDENT (CVA)

18-Apr-13 71923004 F 29 OPDC06A A09 OTHER GASTROENTERITIS AND COLITIS

18-Apr-13 71923004 F 29 OPDC06A L01 IMPETIGO

22-Apr-13 71923004 F 29 OPDC06A H26.9 ALL TYPES OF CATARACT

25-Apr-13 27-Apr-13 71923004 F 29 MEDI23A A09 OTHER GASTROENTERITIS AND COLITIS

25-Apr-13 71923004 F 29 OPDC06A D50. IRON DEFICIENCY ANAEMIA

25-Apr-13 71923004 F 29 OPDC06A B54 MALARIA

26-Apr-13 71923004 F 29 OPDC06A J99. R.T.I

Example of fraud within NHIS Claims on behalf of 1 subscriber 24 visits

Source: National Health Insurance Authority Ghana

ClaimSync Embedding Identity in the Healthcare cycle

Verification

Registration and Card issuance

Health insurance

Member Health provider

Claim Processing

Member Registration Office

Claim Processing Center

System Overview

Healthcare Provider

Member Registration Office

• Create a duplicate-free member database

• Issue a member card Member Registration takes place at a registration center: • Collect biographic data • Collect biometric data • Send biometric data to Central Data

Center for de-duplication • Store member data in central

database • Issue biometric member card

Reg

istr

atio

n O

ffic

e

Cen

tral Data C

enter

De-duplication

Cen

tral D

atabase

Healthcare Provider

• The patient has to proof his identity with a fingerprint

• A Claim Verification Code (CVC) is generated after a correct member verification

• It ensures that the member was present at the time the CVC was generated (proof-of-presence)

• CVC generation is an off-line process

• The CVC must be noted on the invoice

Healthcare Provider CVC Generation

Claim Verification

Code

• The CVC is a 10-digit number that is added to a claim • ClaimSync has been designed to be easily integrated in existing healthcare systems

and supports both paper-based and digital claims

HP ID Date Member ID CVC Other data

Biometric Info BioHASH®

HP ID Claim Date

Context Info

Member number

Biographic Info

Proof of Presence: CVC can only be generated if card-holder is present

Claim Processing Center

• Claim Vetting /Tracking/Auditing takes place at a Claim Processing Center

• The CVC added to the claim allows a simple check-of-authenticity

Biometrically-certified claim

(CVC)

Standard Claim Vetting/

Tracking/Auditing

Claim Payment

Authenticity check using CVC

GenKey Reference

National Health Insurance Scheme (Ghana)

25 Million citizens

NHIS established in 2003 to “secure provision of basic healthcare services to persons resident in the country”

In Partnership with

NHIS – Ghanaian National Health Insurance Scheme

• Fund: exceeding USD 300 Mio per year

• Fund created by 2.5% of VAT on goods and services

• Already 4 Mio+ citizens registered with biometrics

Solution provided:

• Registration at 280 NHIA service points:

• Biographical + Biometrical information

• Direct delivery of a membership cards

• Solution for 3000 Healthcare service providers:

• Biometric verification of patient

• Creation of the “Biometric Claim Check Code”

• Central solution for de-duplication

• Solution for automatically verifying authenticity of claim

Reference: Ghana NHIS

Source: 2011 NHIS annual report

1 USD = 2 GHS

Cla

ims

pay

me

nt

tre

nd

(G

HS

Mill

ion

s)

Year

Claims payment trend increased to USD 275 Million in 2011

$7.4 million Amount charged through fraudulent claims

by providers and recouped by Ghana’s

NHIS in the last two years

Source: Joint Learning Network.

Huge Savings

Embedding Identity – further examples

• Medication: Extending the “proof of presence” down to the pharmacy as a “proof of receipt” - Linking medication to an identity makes fraud very difficult

• Government / International donors Creating a database of entitled individual for donated medication, enabling a full audit trail on the medication received

• Healthcare passports in International Aid projects Clear proof of identity to avoid the high costs of re-examinations

Embedding Identity in the Healthcare cycle

• Ensures correct member identity using cost-efficient member cards

• Results in improved quality of service to members

• Enables tamper-resistant claim generation/verification using unique biometric proof-of-presence

• Supports both electronic and paper based systems

• Leverages on existing process flow

• Easy integration into existing systems of member registration and claim handling

• Supports efficient and transparent claim handling process

• Suitable for Government and private sector

Embedding Identity in the Healthcare cycle

• Patient induced - Impersonation, “sharing” an insurance - Selling prescribed medication

• Provider induced - Claiming w/o having seen the patient - Overbilling (*)

• Fraud induced within the payer system

- Ghost patients

- Sale of medication (esp. from donor’s programs)

19

(*) We can help with that as well – ask the speaker

CONFIDENTIAL

GenKey High Tech Campus 69 5656 AG Eindhoven the Netherlands www.genkey.com

Thank you very much for your time!