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The Resource Center Identity Theft & Protection | post

The Growing Menace of Medical Identity Theft

by Joe Mason on

In recent days, both the Federal Trade Commission and the Centers for Medicare & Medicaid Services (CMS) have both sent out reminders of the growing threat of medical identity theft.

Again, Medical Identity Theft is the use of another person's personal, health or health insurance information to get medical treatment or prescription drugs.

The FBI estimates that healthcare fraud is costing American taxpayers as much as $234 billion annually and that 1.42 million Americans were victims of medical identity theft in 2010.

As in other forms of identity theft, victims are in danger of suffering a financial loss by someone obtaining services in their name and sticking them with the bill. But with medical identity theft just as great a danger, and maybe a bigger threat, is that your medical records and health insurance records might become intertwined with some imposter's.

Your medical records might suddenly contain an imposter's medical information that could be mistaken for your medical information. Every time an imposter receives a test or medical treatment using your name or insurance identification, detailed information may be added to your medical records. It might be a different blood type, an inaccurate history of drug or alcohol abuse, test results, diagnosis of an illness or a condition you don't have, or detailed records of treatments you never received for an illness or condition you don't have.

Any of these could lead to you receiving improper treatment in the future, which ominously could lead to injury, illness or worse.

Here are just two real world examples I have seen recently:

A woman who just had neck surgery couldn't get needed physical therapy following the surgery because, thanks to an identity thief, her physical therapy benefits for the year had been maxed out at a clinic she had never visited.

A pregnant woman, when filling out pre-admission documents for her delivery, learned that someone had used her Social Security number to be treated for a crack overdose. Had doctors thought she was the one in the ER admission for an overdose, her delivery would have been handled very differently, her newborn would have had to undergo drug testing and law enforcement would likely have become involved.

The Federal Trade Commission (FTC) says you might be a victim of medical identity theft if:

  • you get a bill for medical services you didn't receive;
  • a debt collector contacts you about medical debt you don't owe;
  • you order a copy of your credit report and see medical collection notices you don't recognize;
  • you try to make a legitimate insurance claim and your health plan says you've reached your limit on benefits; or
  • you are denied insurance because your medical records show a condition you don't have.

Along these lines, CMS gives some tips on how you can detect medical identity theft. Generally speaking, it involves paying close attention to your medical, medical insurance and financial records which can allow you to spot discrepancies and possible fraud.

Most private insurance companies, and CMS if you are a Medicare or Medicaid recipient, send out monthly Explanation of Benefits (EOB) statements or, in the case of Medicare, a Summary Notice. They are not mere boilerplate; you should read them carefully to see if any treatment, lab test or other item listed is for something that you didn't receive.

Make sure the claims paid match the care you received. The report or statement gives the name of the provider, the date of service, and the service provided.

In my next blog, I'll talk about what you can do to help minimize your exposure to possible medical identity theft and about what you should do immediately if you think you are the victim of medical identity theft.