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Identifying Different Types of Medical Identity Theft: It Can Happen to You

Medical Identity Theft is a High Cost Crime

Norah said she thought it was odd when she received a letter from her insurance company denying a $7,000 insulin pump. She wasn’t a diabetic. That letter should have been an alert that Norah had been a victim of medical identity theft.

If you are denied insurance for a medical condition you do not have, or if you are sent a bill or collection letter for medical services you did not receive, or if you are advised you have maxed out on your medical benefits, consider it to be a blaring siren indicating that fraud has likely occurred and your identity has been stolen.

In Norah’s case, someone had stolen her personal information (her name and Medicare number) and had posed as her to obtain medical treatment, prescription drugs, and very likely other services. Norah’s Medicare was billed and payment of their perceived obligation was paid.

Medical Identity Theft Pays Out Big

Medical identity theft is the fastest growing form of identity theft and occurs when someone steals or unlawfully uses either your (i) personal information, (ii) social security number or (iii) Medicare number to obtain medical goods or services or to fraudulently bill for medical goods or services using an unlawfully obtained medical identity. The identity of a provider and identity of a patient are the two necessary items required for medical fraud to ensue.

You might also like, “Stolen Mail: What to Do When You’re the Victim of Identity Theft”

While the financial impact to Norah was concerning, it was imperative that she notify her doctors and make sure her records were accurate. There are likely now medical records indicating the fraudster’s medical history in addition to Norah’s – which can be extremely dangerous to Norah’s health. As I mentioned, Norah is not a diabetic. What other test results are now in Norah’s medical records? Any such false information could lead to Norah receiving the wrong treatment or even being injured and/or getting ill due to an incorrect treatment.

If You Encounter Medical Identity Theft…

If you see any signs of medical identity theft, you must promptly obtain copies of your records and check them carefully for errors. Federal law provides you the right to know what is in your medical records. If a provider denies your request for your records, you have a right to appeal. Contact the patient representative, or the ombudsman, listed by your healthcare provider in their Notice of Privacy Practices. Explain the situation and ask for your file. If the provider refuses to provide your records within 30 days of your written request, you may complain to the U.S. Department of Health and Human Services’ Office for Civil Rights.

You may also ask each of your health plans and medical providers for a copy of the “accounting of disclosures” for your medical records. The “accounting” is a record of who got copies of your records from the provider. The law allows you to order one free copy of the accounting from each of your medical providers every 12 months.

The accounting includes details about:

  • What medical information the provider sent
  • When the information was sent
  • Who received the information
  • Why the information was sent

This accounting will provide you with the information as to who has copies of your mistaken records and whom you need to contact. The accounting may not include details about routine disclosures of your information, like those from your doctor’s office to another doctor’s office, or disclosure of payment information to an insurer.

Follow the Paper Trail- and Make One Too

Once you obtain your records (there may be a related fee), if you find errors, you must contact the provider seeking corrections. Be specific about the information that is not accurate, whether it be that certain information must be removed (erroneous information) and/or that missing data be input. To do so, I suggest you contact each doctor, clinic, hospital, pharmacy, and/or laboratory where a thief may have used your information.

You may also like, “What a Racket: Tales of Equifax, Experian and TransUnion”

Be sure to use written correspondence and copy your health insurance provider. Circle the inaccurate data, explain why this is a mistake and how to correct it, and provide documentation that supports the accurate data necessary for the record keeper to accurately update your records. Request that the changes be made and forwarded to any related party who may be in receipt of the erroneous information. Keep copies of your letters, emails and records/logs of all related phone calls.

Circle the inaccurate data, explain why this is a mistake and how to correct it, and provide documentation that supports the accurate data necessary for the record keeper to accurately update your records.

Send your letters by certified mail, with “return receipt requested,” so you have a record of what the provider and plan administration received. Follow up a few weeks later to ensure the corrections have been entered. While there may have been a simple mistake, if the correction is not made, report it. You can call 1-800-MEDICARE; the Senior Medical Patrol (a nationwide program whose mission is to work with people who are on Medicare to prevent, detect, deter and report abuse) at 1-877-808-2468; or contact the Office of the Inspector General’s Fraud Hotline at 1-800-447-8477.

An Ounce of Prevention is Worth a Pound of Cure

Hopefully, you are not the victim of medical identity theft. Let’s keep it that way! There are some relatively easy preventative steps you and your loved ones can take to minimize potential victimization by medical identity theft:

  • Protect your health insurance and Medicare cards as vigilantly as you do your credit cards
  • Analyze all medical services/Medicare explanations of benefits, statements, and summaries for suspicious charges. Look specifically for: equipment or medical services you never received, incorrect dates, duplicate billing, or anything else suspicious
  • Limit distribution of your personal information, medical insurance and Medicare cards to your doctors and your medical suppliers
  • Ask questions about security practices at your hospital and doctors’ offices. You must advocate for your privacy and confirm the existence of a cyber-security team, staff security training, protocols and how your data is being protected
  • Check to see if there are any medical collection notices on your credit report
  • Take action if you receive a notice from your health plan stating you have reached your benefit limit or if you are denied insurance because your medical records show a condition you do not have.

Hear Medical Identity Theft Scams Loud and Clear

My friend Steven, who uses hearing aids, asked me if he should be wary of a call he received offering him a free travel accessory kit for his hearing aid. The representative “only” wanted him to provide his Medicare number and told him she would send him the free kit, along with free information concerning the most up-to-date developments in the field. Steven got the feeling that something wasn’t quite right, and his wallet was downstairs, so he smartly asked the representative for her number to call back. He did some investigating before deciding anything “free” that hinged on his providing his personal and medical information was a freebie he was willing to pass on.

Anything too good to be true is probably too good to be true. Beware of anyone offering any free or no co-pay benefit in exchange for your identity.

Shred it, Don’t Regret it

When Tina learned her medical identity was stolen, she was certain it was because her spouse, Len, had refused to shred her medical bills after they were paid. Len had made a pile of “items to shred” and a separate junk pile that was simply placed in the trash. Len was of the opinion that only bank statements, credit cards and documents with their social security numbers should be shredded. In Len’s opinion, junk mail which he characterized as harmless statements – the lawn care and pest control as well as paid medical bills – didn’t contain sensitive information and could simply be thrown out.

While Tina later found out that this was not the cause of her medical identity theft, this raises an important point: medical bills and statements do contain extremely sensitive and identifying information and must be protected. If you do not intend to save the hard copy of such statements (after scanning them into your computer), be sure to shred them. Also shred health insurance forms, prescription and physician statements, and even the labels from prescription bottles.

And, on that note, to the extent you do save your records on your computer, use complex passwords, mixing in numbers and symbols, to keep your data protected. Keep paper and electronic copies of your medical and health insurance records in a safe place.

You might also like, “How to Protect Your Passwords: 4 Tips”

Tina learned the agency she used for physical therapy was involved in a medical identity theft ring, and that was how her medical identity was stolen. In fact, it is not just con-artists. Medical identity theft is often an insider crime, whereby workers who have access to patient information either take it themselves or  provide the ill-gotten information to medical identity “theft gangs”.

Another common way people unwittingly fall prey to medical identity theft is when they provide their personal information at a “free health screening” at the mall or even in parking lots. While you may get the benefit of a free screening, the scammer gets much more. Using your personal information, they can charge for unnecessary medical equipment and services.

Also, be aware that no one from Medicare will ever call you and ask for your social security number or your Medicare number. If you receive such a call, hang up. Do not share medical or insurance information by phone or email unless you initiate the contact and know who you are dealing with.

Also, be aware that no one from Medicare will ever call you and ask for your social security number or your Medicare number. Click To Tweet

Victims of medical identity theft may, as a direct result, receive delayed care or worse yet, be completely denied services as a result of the fraud.

If you suspect you have been a target, act immediately. In addition to all of the above, order your credit reports and consider placing a fraud alert or security freeze on your credit files.

Such action can literally save your life! Protect yourself.

About Michelle Gershfeld

I’m a debt settlement and bankruptcy attorney who negotiates resolutions between clients and their creditors. I am also a real estate attorney involved in both sides of purchasing and selling distressed real property. I am passionate about teaching people about money and helping individuals of all ages achieve financial independence and success in a "no…

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