Medical ID Theft
We have all heard the horror stories of thieves stealing an individual’s credit identity to rack up bills that result in a host of nightmares for the victim. But, have you considered the possibility that the same sort of criminal may be targeting your medical identification?
Alarmingly, there has been an increase of cases involving criminals who use the ‘medical identity’ of another to receive medical care in someone else’s name. The victim of the fraud ends up with bills for medical care they did not receive and, in some instances, diagnosis and treatments listed in databases that do not belong to them. The financial cost can be overwhelming and the possibility of malpractice frightening.
What can you do to safeguard your medical identity? Here are a few suggestions:
1. Treat your medical insurance card like you would a credit card. If lost, report it immediately to your insurance company. Don’t show your insurance card to or loan it to anyone other than trusted healthcare providers. At the medical facility, do not stand at the counter and rattle off insurance information that includes the numbers, social security number or birth date.
2. Read those EOBs! Insurance companies issue Explanation of Benefits when a provider is paid in your name. Look over those EOBs and quickly report mistakes to your insurance company. Shred EOBs if they include policy number, etc. Check that procedures billed to insurance company are accurate. Fraud schemes include providers billing for more expensive procedures, procedures not performed, charges for a specialist that wasn’t seen, ‘nurse’ visits when a trip to the lab would do, equipment not used and ‘splitting’ one procedure into multiple procedures in order to bill at a higher rate.
3. Check out benefits paid every year. Do a yearly check up on claims paid on your behalf. Quickly report any that you do not recognize. Make sure that your address or other contact information is accurate.
4. Watch out for scams! Clinics and physicians have been prosecuted for filing false bills covering tests and procedures that have never been performed. To avoid being a victim, avoid clinics that waive co-pays, offer ‘free’ tests, exams, transportation, etc. Again, check those EOBs for errors! I recently found an $11,000 error.
5. Check your credit rating. If someone has run up medical bills in your name, especially with false address, etc. you may likely find claims from credit agencies on your credit rating.
6. Ask for an accounting of disclosures. You have the right under HIPAA to get this document from every health care provider you visit. This document will let you know to whom information was released, when it was released and what information the provider received. As some medical databases are not interconnected, this is another way to track errors in your medical history.
7. If you find errors, what should you do? First, contact the provider and your insurance company. It may simply be a ‘coding’ error or honest mistake on the provider’s part. If it is not an error or you suspect fraud, contact your insurance, and keep records of who you speak to. Most insurance companies will aggressively pursue cases of suspected fraud. Report the fraud to your police department and receive a copy of the report. Other agencies will also investigate medical fraud. These include:
- · City, County, State and Federal Law Enforcement Agencies
· Justice Department through the Assistant
· U.S. Attorney General’s Office
· Federal Bureau of Investigation (FBI)
· Postal Inspectors
· Department of Health and Human Services (HHS)
· Food and Drug Administration (FDA)
· Offices of Inspectors General (OIG)
· U.S. Department of Labor
For more information, check out these websites:
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