Medical I.D. Theft

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Medical identity theft is when someone steals or uses your personal information (like your name, Social Security number, or Medicare number), to submit fraudulent claims to Medicare and other health insurers without your authorization. A thief may use your name or health insurance numbers to see a doctor, get prescription drugs, file claims with your insurance provider, or get other care. If the thief’s health information is mixed with yours, your treatment, insurance and payment records, and credit report may be affected.

Signs of medical identity theft include:

  • a bill for medical services you didn’t receive
  • a call from a debt collector about a medical debt you don’t owe
  • medical collection notices on your credit report that you don’t recognize
  • a notice from your health plan saying you reached your benefit limit
  • a denial of insurance because your medical records show a condition you don’t have.

How medical records get compromised:

Your medical records can be a mix of a criminals information and your stolen personal identifiable information (P.I.I.).  Data breaches and the Dark web marketplaces are the most common sources of stolen medial information.  Breaches of unsecured protected health information affecting 500 or more individuals are reported to the U.S. Department of Health & Human Services.  

Click here for a complete list of all reported data breaches involving personal medical records.  

Tips for Consumers

  • Don't give out unnecessary information - It may not sound like a dangerous request, but allowing your doctor's office to photocopy your driver's license or credit card is not a smart move, and often isn't even required to receive services. If you're asked by the front desk to provide anything other than your insurance card, ask why it's needed and how the office plans on protecting your information. If you're not comfortable with their answer, then don't give them your ID or credit card.
  • Read every explanation of benefits - These statements are documents sent by your insurance company which list medical services you received and how those services were paid for.  They are complicated and can be difficult to interpret, especially for those with multiple health conditions and frequent visits to providers. Look at things like dates of service or provider names. If you see something you don't recognize, follow up right away. Velasquez said.
  • Get a copy of your medical records - Under the Health Insurance Portability and Accountability Act (HIPAA), you are legally entitled to a copy of your medical and billing records held by health plans and providers.  Once you have these records, keep it somewhere safe and add new information each time you visit a doctor. This way you'll have proof if it was altered if someone begins using your information illegally.

    Online Access to Your Health Information - http://www.aafa.org/page/accessing-your-medical-records.aspx

    Some hospitals, doctors’ offices and clinics may provide access to a website that stores the personal medical records of their patients. Depending on the websites’ features and functions, you may be able to view your test results or a list of your medications, access your medical records, schedule appointments, obtain follow-up instructions, pay bills and refill prescriptions. Check with your providers or physicians to see if they offer online access to your medical records. Terms sometimes used to describe electronic access to these data include “personal health record,” or “PHR” or “patient portal.”

    Ask for corrections if there are errors in your health information:
    Write to your health plan and medical providers and explain which information is not accurate. Send copies of the documents that support your position. You can include a copy of your medical record and circle the disputed items. Ask the provider to correct or delete each error. Keep the original documents.

    Send your letter by certified mail, and ask for a “return receipt,” so you have a record of what the plan or provider received. Keep copies of the letters and documents you sent.

    The health plan or medical provider that made the mistakes in your files must change the information. It should also inform labs, other health care providers, and anyone else that might have gotten wrong information. If a health plan or medical provider won’t make the changes you request, ask it to include a statement of your dispute in your record.
  • Periodically review credit reports.
  • Maintain control of medical identity cards. Lost or stolen Medicare and Social Security cards should be reported right away to the Social Security Administration. 
  • Review everything - This includes medical benefit explanations, medical bills, and prescription invoices and report questionable charges or fraud.
    Questionable Charges?  Contact your health care provider first to see if it's a mistake. If your issue is not resolved by your provider, report the questionable charges to 1-800-MEDICARE or contact your local Senior Medicare Patrol for assistance: 1-877-808-2468 or www.SMPResource.org.