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AI, Identity Risk, and Governance in Healthcare

AI is changing healthcare in powerful ways. It’s helping with diagnosis, improving patient care, and speeding up admin work. But there’s a growing downside: fraud powered by AI is on the rise — and healthcare is a top target.

Fake identities, deepfakes, and AI-generated documents are getting harder to spot. And they’re slipping through systems that weren’t built to stop them.

This isn’t just an IT issue. It’s a governance issue — and healthcare leaders need to act.

What AI-Powered Identity Fraud Looks Like

AI fraud in healthcare is fast, smart, and hard to detect. Here are a few real examples:

• Fake doctors submitting false claims using AI-created credentials

• New patient accounts built from synthetic (fake) identities

• Deepfake calls or videos targeting staff at intake or support desks

Medical identity theft is also one of the hardest to fix. Experian reports the average cost per case is over $13,500.

Why This Matters

AI-driven identity fraud doesn’t just cost money. It damages trust and puts patients at risk. If a fake identity enters your system, it can:

• Violate privacy rules like HIPAA

• Change or corrupt medical records

• Harm real patients through misdiagnosis or false treatments

• Lead to investigations, fines, and reputational damage

Where Healthcare Systems Are Most at Risk

Many healthcare organizations have strong security — but still face risks like:

• Weak identity checks for patients or providers

• No ongoing monitoring after sign-up

• Gaps in vendor security and third-party systems

• No clear AI use policy or oversight team

What Healthcare Leaders Can Do

There are clear steps your team can take to reduce risk and stay ahead.

1. Set AI and Identity Policies

Define how AI is used in your organization. Assign responsibility. Review how identity checks are done and when human review is required.

2. Use Verified Digital Credentials

Move away from usernames and passwords. Let patients and staff use secure, verified digital IDs that can’t be easily faked.

3. Check Identity More Than Once

Fraud can happen at any time. Add verification during key touchpoints like appointments, prescription refills, or system logins.

4. Train Teams on What to Look For

Staff should know how to spot suspicious signs of AI fraud. Teach them to flag anything that seems off — especially in support, billing, and intake.

5. Review Vendors

Make sure every app, tool, or system you use has strong security and identity protection. Ask vendors how they handle AI risk.