Medical Identity Theft

Medical identity theft involves stealing medical records, medicare benefits, insurance cards and credit accounts, which are all used to pay for medical services and goods. This type of theft oftentimes results in incorrect entries being put into existing medical records, and it can also involve fictitious medical records being placed in the victim’s name. Medical identity theft is the hardest of all the identity thefts to rectify because victims have limited rights and resources. Falsified medical records can negatively affect victims’ medical and financial lives for years. This includes:

• False medical and pharmaceutical bills as well as health insurance claims
• Denial of health insurance claims and coverage along with life insurance claims and coverage
• Denial of employment
• Wasted time and costly expenses trying to correct false medical records

Currently, there is no officially designated process medical identity theft victims can follow to dispute false claims or correct erroneous information within their records. However, individuals can still prevent against medical identity theft by following the below tips:

Gather all medical records

Individuals should gather all of their medical records by contacting each of their medical providers. It is important to gather this information before an attempt is made by an identity thief to steal it. All medical records should be gathered and sorted at least twice a year.

Stay on top of all medical insurance claims

Individuals should contact their medical insurance representatives, and request documents for every claim filed and paid by them.

Look over all invoices

All invoices received from providers should be analyzed thoroughly to ensure that individuals understand the terms and conditions. Insurance benefits should also be reviewed for understanding.

Obtain a credit score

All individuals should obtain a credit score three times a year, and all credit scores should be reviewed for any suspicious activity. This includes any address changes, inquiries, and unauthorized accounts and charges.

Obtain a complete list of medical payments yearly

A complete list of medical payments should be obtained from individuals’ insurance companies. By doing this, individuals will be able to see if any unauthorized medical surgeries or prescriptions have been charged to their insurance.

Other Preventative Measures

In addition to following the above primary tips, individuals should also:

• Only share health insurance information with trusted providers exclusively
• Check credit histories and medical histories for medical liens
• Contact insurance companies and medical health providers if charges for unauthorized care appear on medical bills or insurance reports
• Demand that all medical history errors be corrected by insurance companies and providers immediately.
• Always protect insurance cards, explanation of benefits and any health plan correspondences
• Do not provide any insurance information to telemarketers or solicitors

What to do if Victimization has occurred

Even though there is no officially designated procedure for responding to medical identity theft, individuals can still take steps to try to rectify the problems. If individuals have become victims of medical identity theft, they should respond to the incident immediately by:

1. 1) Contacting either the privacy officer at the provider organization, the health information manager or the anti-fraud hotline at the health plan where the theft has occurred.
2. 2) Requesting an accounting of disclosures. Individuals can file a complaint if the provider or plan refuses access to their medical records. Complaints can be filed by calling Health and Human Services’ Office for Civil Rights at (866) 627-7748.
3. 3) Taking extensive notes on all correspondences and documents related to the medical identity theft. All contact information of everyone contacted should be documented as well as the correspondences’ content.
4. 4) Working with the organization where the medical theft occurred to determine where erroneous information was sent, stop the flow of that erroneous information, and to correct existing inaccurate medical records.
5. 5) Filing a police report, and sending copies of it along with correct medical information to all insurers, providers and credit bureaus
6. 6) Checking with state authorities for additional resources. Numerous states provide individuals with information on insurance and medical fraud.
7. 7) Contacting the Office of the Inspector General, HHS TIPS Hotline at 1-800-447-8477 if Medicare or Medicaid fraud is suspected
8. 8) Reviewing all health records to ensure they have been corrected before seeking healthcare

Generally speaking, every organization that handles individuals’ health information should have some sort of procedure for medical identity theft. It is imperative that individuals contact all organizations related to their medical identity theft, and ask about their specific policies, procedures and response teams. Individuals should also follow the regular procedures for dealing with identity theft in addition to following the above procedures specifically for medical identity theft. This includes obtaining credit score, issuing fraud alerts, and contacting the Federal Trade Commission along with credit bureaus and agencies.