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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

Industry News, Fraud and Abuse, Security

Medical Identity Theft on the Rise

Posted by Michael Rosen, ESQ on Thu, Oct 05, 2017

Medical Identity Theft National Cyber Security Awareness

October is National Cyber Security Awareness Month and there’s something on our mind that we would love to discuss - identity theft. Those two simple words send shivers down our spine. Identify theft crime is the fastest growing white collar crime in the United States. We have all seen, read or heard about this callous crime as it has caused widespread public devastation with incidents like the Target breach, Anthem Health Plan, and Equifax to name a few. It’s an invasion of our privacy and an attack on our individual security.

What most people don’t know about is medical identity theft. Let’s take a look at how this issue is defined and the impact it is having in the healthcare community.

A new report by the Office of Inspector General (OIG) highlights the harmful effects of medical identity theft and offers support on what you can do to protect yourself. Medical identity theft is when someone, without your knowledge or consent, steals your personal information such as Social Security Number, Medicaid Number and Date of Birth, to submit fraudulent claims for medical services or products. In some instances these crimes involve false claims to Medicare or Medicaid as well as private health insurance companies.  

Medical Identity thieves have figured out ways to submit false claims in your name in order to get paid for services that were not rendered or even for equipment you did not order. What makes this crime even worse is the fact that from that point forward, your medical record may have incorrect information about you, which could cause life threatening consequences

For example, if a thief uses your identity to get reimbursed for an expensive insulin pump, the next time you arrive at the ER, your record could reflect that you are a diabetic. Or, what if they use your identity to get a simple physical which results in a diagnosis of high blood pressure? Think about if they had an elective surgical procedure - you could have an incorrect record of your health that could cause harm if the doctor does not have an accurate picture of your medical condition or treatment which you may or may not have received.

The University of Miami Health System published a report on medical identity fraud and found the following:

There are many consequences when dealing with medical identity theft.  The patient may fail a screening exam for employment due to the presence of diseases and other conditions in their health records.  The victim may receive inappropriate medical treatment including harmful medication.  They may exhaust their health insurance benefits and potentially lose both life and health insurance coverage.  Ultimately, the victim may have issues with their credit report; receive unpaid bill notifications, and harassing phone calls from collections agencies”.

Medical identity theft is usually an insider crime. For instance, a worker at a healthcare facility has more than enough access to personal data that is needed to perpetrate a crime. They can use it themselves or sell it to other interested parties. Sometimes this will be used to set up fake clinics to draw in patients. The payments are collected and used for personal gain. The fake shop is set up and closed before authorities can trace it or stop it. 

Steps to help prevent identify theft:

  1. Check your Explanation of Benefits carefully. You will receive an EOB from your insurance carrier which lists items they have received and are paying on your behalf. If there are services listed that you did not receive, call the carrier immediately.
  2. At least once a year, request a summary of benefits paid on your behalf.
  3. Monitor your credit report for collection activity on unpaid (false) bills.
  4. Request a full copy of current medical files from each healthcare provider you visited and examine it carefully-especially for medications and pharmacy items.

Other resources:

Consumer Reports | Medical Identity Theft

OIG Podcast: Health IT Security | Oct. 4

Kroll Identity Monitoring Services

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Written by Michael Rosen, ESQ

ProviderTrust Co-Founder, [email protected]

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as: Inc Magazine's Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year.

 Connect with Michael on Linkedin 


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