The Justice Department has charged 455 individuals in their annual crackdown on health care fraud, with the cases linked to over $6.5 billion in false claims. This year saw more state Medicaid departments involved than before, and among the defendants, 90 are medical professionals, including doctors. However, these allegations will still need to be proven in court.
In various instances of wrongdoing, many individuals used someone else’s medical identification. Additionally, prosecutors have leveled charges of aggravated identity theft across multiple states. One notable case from Virginia involved a mental health company co-owner who allegedly paid homeless individuals for shelter, then billed Medicaid for services that were never actually provided.
For those whose medical IDs have been misappropriated, while some cases might eventually be closed, the complications for their medical records could linger. If someone else’s treatments are recorded under your name, inaccurate information could insert itself into your medical history. This misrepresentation can lead to issues down the line, particularly when you need to use your insurance.
Treatment of Identity Thieves is Written to a File
The Federal Trade Commission (FTC) defines medical identity theft as the unauthorized use of someone’s personal health information—such as their name, Social Security number, or Medicare details—to obtain medical services, equipment, or file claims. When fraudulent medical bills are generated in your name, the thief’s health information could inadvertently merge with yours. This can severely impact your medical care and benefits since your provider may reference mixed records, which could include incorrect prescriptions or allergies.
Data Breaches Could Fuel Medical Information Theft Market
Data breaches at hospitals and insurance companies, while not all leading directly to fraud, can result in valuable health information being stolen. For example, NYC Health + Hospitals experienced a breach affecting about 1.8 million individuals, with files containing sensitive data like health insurance info and biometric details being copied.
Once personal information enters the criminal sphere, it can be repurposed for billing fraud in someone else’s name.
Treat Your Insurance Card Like a Credit Card
The FTC advises treating medical numbers just as you would credit card details. Here are a few safety tips:
- Store enrollment forms and benefit statements securely and shred them before disposal.
- During doctor visits, consider using a different identifier instead of your full Social Security number.
- Stay cautious of unsolicited offers for free treatments in exchange for your Medicare details, as these are often scams.
- Create or access your secure Medicare account regularly to monitor your bills and any unfamiliar charges.
Your Credit Report May Not Report This Fraud
It’s essential to recognize that fraudulent medical claims bypass traditional credit checks. The FTC highlights some things to watch for:
- Receiving bills for services you didn’t receive.
- Being contacted by debt collectors regarding medical debts that aren’t yours.
- Noticing collections that don’t appear on your credit report.
- Insurance notifications indicating you’ve reached your benefit limit.
- Surprising services listed on your Medicare Summary Notice.
First Thing to Do If You Think Your Medical Bill is Incorrect
If you spot discrepancies in your medical bills or Medicare notices, take action promptly and document everything:
1) Call Your Insurance Company or Medicare
Use the number on the card; don’t trust random communications.
2) Get Billing Details
Request specifics like the provider’s name and service dates.
3) Request Written Records
Formally ask your healthcare provider for any relevant documents regarding your claim.
4) Report an Error
Notify your insurance fraud department about the discrepancies.
5) File an Identity Theft Report
If your identifying information has been misused, file a report at IdentityTheft.gov for help and to document your situation.
6) Save All Documents
Keep track of all communications, including bills and reports.
Correcting Medical Files Takes Longer Than Contesting Charges
To rectify any paperwork, request records from all involved parties and report errors in writing. Under HIPAA, healthcare providers generally have up to 30 days to respond to record requests, though extensions can happen. However, getting corrections to your medical record can take additional time, as providers may hesitate to release records containing a stranger’s information.
If you don’t receive your documents within the required timeframe, you can file a complaint with the U.S. Department of Health and Human Services.
A Credit Freeze Alone Will Not Stop Insurance Claims
While a credit freeze can block new accounts, it won’t impact existing claims related to your insurance number. Thus, monitoring where your personal information is used is critical.
Identity theft protection services can keep an eye on various platforms to identify misuse of sensitive information. Plus, some services offer fraud resolution assistance to help with disputes and working with healthcare providers. Although these services can’t prevent all medical identity theft, they can flag potential issues more quickly.
Key Takeaways
Medical identity theft is a hidden threat, often occurring without regular check-ups. While stolen credit cards can be canceled quickly, stolen Medicare or insurance numbers can lead to long-term issues, such as false claims. It’s vital to keep an eye on your health records and treat your insurance card with caution. Prompt action is essential; reach out to your insurance provider and document everything to safeguard your interests.
Have you come across a medical bill for services you didn’t receive? Sharing experiences can help others. Please reach out with your story.
