Red Flag Rule

Short of asking for proof that the child belongs to the adult, it becomes very difficult to detect when someone is attempting fraud but appears to have all the right documentation. While I am not certified as a compliance officer nor am I an attorney, I would suggest that employees be educated on the various ways in which these things can happen. I also suggest that the senior staff devise a process and procedure that would assist in this situation. It might also include bringing in one or two mother volunteers to assist with input as to best approaches. Medical Identity theft at best sticky because we will never 100% know that someone is misrepresenting themselves or others. Therefore "reasonable effort" becomes the rule of the day. Situations such as what you describe above do happen and if they occur in your office they should be red flagged... hence the name of the regulation. They should be discussed. In addition, IMHO, it wouldn't hurt to pull the "mother" aside and let her know that by doing such as act that she places the practice in legal jeapardy. Then offer that if the "mother" can prove she has custody of the child that you welcome a copy for the child's record" Otherwise ask if the real mother can provide permission for her substitute to bring the child to the office for care. Then document the situation.