Medical Identity Theft

Identity theft comes in many different forms.  In fact, on an annual basis the Federal Trade Commission reports on 30 different types of identity theft as they tally the number of reports they have received from year to year.  What typically makes the headlines is bank and credit card fraud, but these types of identity theft only account for about 30% of all identity theft reported. One of the lesser talked about types of identity theft that can have long term consequences is Medical identity.  While only 2% of all FTC-reported identity theft is this type, medical identity theft is one of the most serious crimes in this fraud category.  The AARP shows us that cases of medical identity theft are increasing exponentially, with reports to the Federal Trade Commission rising from 6,800 cases in 2017 to nearly 43,000 cases in 2021. 

What Is Medical Identity Theft? 

According to the U.S. Department of Health and Human Services, medical identity theft occurs when someone steals or uses your personal information (such as your name, Social Security number, insurance information, or Medicare number) to submit fraudulent claims to Medicare and other insurance providers for services or equipment, without your authorization. This type of crime can disrupt the victim’s access to services and cause them considerable financial harm.

How Does It Work?

There are a variety of ways this scam can happen. Often, medical identity theft is a “friendly crime,” which means the scammers know the victims, and about half the time, the theft occurs between family members. Usually, this is without the victim’s knowledge, but there are also instances of a person knowingly sharing their insurance information and identification with the intention of helping a loved one. This is still fraud, with both parties culpable, and often leads to future unexpected complications with medical records. 

Three common ways medical identity theft typically occurs are:

1. Someone uses your personal information to have surgeries or tests done, and has the bill sent to you or to your insurance provider. 

   • An example of this would be someone taking your ID and insurance card and claiming to be you, in order to use your medical benefits for a procedure they need.

2. An individual uses your information to purchase medical equipment or obtain prescriptions. 

   • This might occur through a phone scam, where a scammer calls and claims to be from Medicare or your insurance provider. While they might say they simply need to verify your information to send you free medical equipment, they are actually stealing your information to have the equipment sent elsewhere. 

3. A health care provider of services or equipment uses a patient’s information to file false insurance claims. 

   • A disreputable medical provider might file superfluous claims for a patient’s care. While the services were not provided, the charges will still show up on the patient’s medical and insurance records, and the provider will be paid for the fraudulent charges.   Meanwhile the patient is left with deductibles and co-payments for services they never received.

Why Medical Identity Theft Is Dangerous

Medical identity theft can disrupt your medical care and waste taxpayer dollars. In extreme circumstances, it can even be life-threatening if it creates inaccuracies in your personal medical records. 

Financially, while consumers are protected from liability over $50 for fraudulent credit card charges, there’s no such protection for medical fraud. Losses can be in the thousands of dollars and the financial repercussions can last for years, with high medical debt and impact to credit reports. 

Medically, the history of a scammer that gets treatment in your name could become part of your patient history, and their test results and diagnoses can affect your future medical care. When someone is rushed in for an emergency, countless errors could occur during treatment if records are combined with another individual’s. Life-threatening medical record inaccuracies could range from an incorrect blood type listing to the exclusion of critical drug allergies. Additionally, a patient could be denied coverage or treatments due to previous procedures or red flags in their medical history. Needed prescription medications could also be denied because of quantities that appear to have already been dispensed. 

There are ways to protect yourself and things to look for to ensure your medical identity is safe. Watch out for these warning signs that indicate that you could be a victim of medical ID theft. 

• You are billed for medical services that you didn’t receive. 

• You are contacted by a debt collector for medical debt you are not aware of owing.

• Your credit report includes medical expenses that you did not incur. 

• You receive an Explanation of Benefits (EOB) document from your insurer that includes services or equipment you never requested. 

• Your insurance provider says you’ve reached the limit of your benefits, based on treatments you didn’t receive. 

• You discover incorrect information in your personal medical records. 

• You are denied insurance coverage because of incorrect information in your medical records.

• You are denied treatments due to a medical history that isn’t your own. 

How To Protect Yourself

In addition to the ways you can protect yourself from identity theft, there are specific steps you can take to protect yourself from medical identity theft. 

1. Protect your medical documents. Insurance cards should be reported stolen along with credit cards in the case of a stolen wallet or purse, and medical bills and EOBs should be shredded, not just thrown away. 

2. Just like your personal identifying information, never give out your medical information via phone or email. Scammers will pretend to be insurance company employees, a worker in your doctors’ offices, or a pharmacist to try to get this information from you. If you aren’t sure if a requester is legitimate, ask who they represent, and then call back using a number you are familiar with to verify the need. 

3. Don’t fall for “free” giveaways in exchange for your information. A phone call may state that you are being provided “free” services as part of a survey or a subsidy from a drug or medical equipment company.  Contact your insurance company and ask about the giveaway or get help from a family member or friend to determine if the offer is legitimate before giving out any information over the phone.  

4. Read your medical bills carefully to make sure they match up with the services you receive. Verify that the name of the provider and the facility are accurate, and the dates of service match your records. Ask questions of your provider’s office or insurance company when you aren’t sure about something.

What To Do

If you receive a bill for a medical service you didn’t have or notice an error in your medical records, contact your health care provider first to see if it’s a mistake, and then reach out to your insurance company. 

If you are a <EMBEDDED ACCOUNT> holder and you think you have been a victim of medical identity theft we can help.  We will put you in contact with an Identity Theft Advocate who can assist you in determining the next steps to take.  Whether your issue is medical identity theft or more traditional identity theft, these specialists are ready to guide you through the process of recovering your good name.