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Medical Identity Theft

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CONTENT PROVIDED BY THE NEW YORK ALLIANCE AGAINST INSURANCE FRAUD

Identity theft has spawned a vicious new kind of crime: medical identity theft. Thieves steal your personal information to line their own pockets with fraudulent claims against your own health policy.

Medical thieves can heist your health-insurance number, Social Security number and other personal information. Often the information is stolen by employees at medical facilities, and resold on the black market. Thieves also may hack into medical databases or break into medical facilities.

Medical ID theft can cost you thousands of dollars, constant stress, and even threaten your life and health. Unless you check your medical records closely, you may discover you were defrauded only after the damage has been done.

THE SCAMS

Illegal and bogus treatment. Medical ID thieves bill your health plan for fake or inflated treatment claims. The crooks often are doctors and other medical personnel who know how the insurance billing system works. Organized theft rings also are involved. They buy stolen patient information on the black market, and set up fake clinics to make bogus claims against the health policies of honest consumers.

Buy addictive drugs. Medical personnel with access to your data may use your identity to obtain prescription drugs to sell, or feed their own addictions. Dishonest pharmacists might bill your policy for narcotics, or nurses may call in prescriptions in a patient’s name but pick it up themselves.

Obtain free treatment. Medical ID thieves who don’t have their own health coverage often receive free medical treatment, courtesy of your policy. They assume your identity at a hospital or clinic, and your policy receives the bills.

THE PRICE YOU PAY

Medical ID theft can cause serious and long-lasting damage. Recovering can take years.

Ruined credit. Thieves often ring up large hospital bills in your name, then disappear without paying. This can ruin your credit. Straightening out inaccurate credit records can take months or even years of time-consuming headaches. Meanwhile, you could be hounded by bill collectors, turned down for loans or mortgages, and forced to pay higher lending costs. You also could lose jobs; some employers check a candidate’s credit history.

Loss of health coverage. Fraudulent insurance claims can max out your health-policy limits. This can leave you with no coverage when you have a medical emergency, or need an expensive operation or other treatment.

Inaccurate records. Medical ID theft can threaten your health or even life. A thief’s treatment history can end up on your medical records. This could include the wrong blood type, or medicine to which you’re allergic. Your life thus could be on the line if you receive the wrong treatment based on the thief’s treatment. Your records also could be falsely saddled with damaging — and inaccurate — diagnoses such as mental illness. This could follow you throughout your life.

Legal troubles. A pregnant woman stole the medical identity of a mother, and delivered a baby who tested positive for illegal drugs. Social workers tried to take away the real mother’s four children, falsely thinking she was the addict. She had to hire a lawyer to keep her family.

Higher health premiums. False claims against a health insurance policy can raise your health premiums — costing you yet more money.

FIGHT BACK

Here are ways you escape the scourge of medical ID theft.

Examine your EOBs. Review the explanation of benefits (EOB) form sent by your health insurer. If you see treatments you never received, immediately notify your insurer and medical providers.

Monitor your insurance benefits. Ask your insurer for a listing of benefits paid out under your policy. Do this at least once a year.

Check your medical records. If you suspect you’re a victim of medical ID fraud, get a copy of your records from your doctor, hospital, pharmacy or laboratory.

  • Appeal refusals. If you’re refused access to your medical files, you may appeal by following the steps in your medical provider’s “notice of privacy practices.” You’re entitled to a statement of this policy upon request, and without cost. If you still aren’t satisfied, file a health-privacy complaint with the U.S. Department of Health & Human Service at http://www.hhs.gov/ocr/contact.html or call toll-free 1-800-368-1019.
  • Protect your credit. Review your credit reports with the credit agencies Equifax, Experian and TransUnion to see if anyone has rung up unpaid medical bills in your name. Place a fraud alert and credit freeze on your credit reports if you’ve been scammed. A fraud alert means the bank or other creditor will contact you to confirm your identity when anyone applies for credit in your name. A credit freeze means someone can access your report only with a personal identification number.
  • Correct inaccurate medical records. If you find errors in your medical files, have them corrected immediately. Also realize that your physician, hospital, insurance company, medical lab and others may have the same inaccurate information. Try to track down all possible sources.

But be warned: Correcting records can be hard. In general, federal law lets patients correct medical records created only by the medical provider or insurer that now maintains your information. A hospital or insurer that later receives your information doesn’t have to correct its records—even when they’re wrong. But… you do have the right to have your records state that you disagree with the information, and why. Be sure your complaint is entered into your records.

  • File a police report. Filing a police report will notify law enforcement a crime may have been committed. Also send the report to your insurer, medical providers and all credit bureaus.
  • Notify the government. File a medical identify theft complaint with the Federal Trade Commission (FTC) or call the FTC’s tollfree hotline at 1-877-IDTHEFT (438-4338).