Understanding the Complex Puzzle of Medical Identity Theft

Understanding the Complex Puzzle of Medical Identity Theft

What is it?

Medical Identity theft is the illegal use of another individual’s information in an attempt to obtain medical treatment, services or goods. The victim’s date of birth, Social Security number, address, healthcare identification number, medical data such as past and present conditions, prescriptions, and online medical account credentials may be stolen. A criminal can use the stolen information to visit a doctor, file fraudulent insurance claims, obtain prescription drugs to sell on the black market, and purchase costly medical services.

Most people are primarily concerned about the misuse of their credit or financial accounts but medical identity theft can actually be more costly to victims than other types of identity theft. Generally, federal law limits a consumer’s liability for fraudulent credit card charges to $50, but victims of medical identity theft often do not have similar protections.

How are Victims Impacted?

Identity thieves may run up large hospital bills in the victim’s name and then disappear, leaving the victim completely unaware until they are contacted by creditors. By the time it takes the dispute to be resolved, credit ratings may be negatively impacted and future insurance costs might be affected.

According to a report, damage from medical identity theft can last for years, with some victims suffering long-term consequences of aggressive medical debt collection or facing prosecution after thieves used their identities to purchase hoards of prescription drugs. The victim’s health could be at risk if the thief’s medical information ends up in the victim’s electronic health record.

Potential signs of Medical Identity Theft:

  • An Explanation of Benefits (EOB) bill for medical services or Medicare summary notice outlining services that you never requested or received
  • A call from a debt collector about a medical debt you don’t believe you owe
  • Information you don’t recognize (such as an incorrect address of date of birth) when you verify your information before a doctor’s appointment or other medical treatment
  • A mistaken notice from your health plan that you reached your benefit limit
  • Denial of insurance because your medical records reflect a condition you don’t have
  • A medical collection notice on your credit report that you don’t recognize

Steps to Better Protect Yourself:

  • Review medical and insurance statements – Were you charged for any medical services or equipment that you didn’t request or receive? Do the dates of services and charges look unfamiliar? Were you billed twice for the same service? If you see anything suspicious, contact the provider or your insurance company right away.
  • Don’t overshare – For example, many standard forms ask for a Social Security number, but you may be able to leave that field blank. If you don’t understand why your doctor needs a particular piece of information, ask whether it’s necessary.
  • Know who you’re talking to – Do not share medical or insurance information by phone or email unless you initiated the contact and are positive you are speaking with the correct organization. Don’t answer questions from a caller who says they are conducting a health survey and needs your Medicare or insurance number; this may be a scam.
  • Be cautious when providing information online – Find out why the information is needed, how it will be stored, and whether it will be shared and with whom before providing sensitive personal information on a website.
  • Safely store or shred medical and health insurance documents – Store paper and electronic copies of your medical and health insurance records in a safe and secure place. Shred outdated health insurance forms, prescription and physician statements, and prescription bottle labels before throwing them away.
  • Be skeptical of free offers – if someone offers you free healthcare services or products but asks for your health plan ID number, be wary. Medical identity thieves may pretend to work for a doctor’s office, insurance company, clinic, or pharmacy in an attempt to get you to disclose sensitive information.
  • Request access to your medical records –Under the Health Insurance Portability and Accountability Act, it is your right to request copies of your health information. Review your medical records for red flags just as you may regularly review your credit reports. Ask your insurer for a full list of benefits paid in your name at least once a year. 
  • Know your rights – A healthcare provider may not be willing to give you access to your medical records if the request is related to medical identity theft. A provider may question whether the federal health privacy law permits disclosing a record that may contain another person’s personal health information. Consider showing the provider the guidance offered by the Office for Civil Rights, which enforces the health privacy law. You can file a complaint with the Office of Civil Rights if your provider still resists.
  • Take proper action if you receive a breach notification – If you discover that your medical information has been stolen, try to determine exactly what was stolen and make a remediation plan. Alert your insurer so they can note it in their records and flag your account number if you receive a notification that your health insurance or health plan number was compromised.  Seek professional help or contact the Federal Trade Commission for assistance.

Want further protection against medical identity theft? Get Medical and ID Theft Monitoring from MedCareComplete! Contact us today. 

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