SouthernWorldwide.com – The Justice Department recently announced charges against 455 individuals in its annual National Health Care Fraud Takedown, involving over $6.5 billion in alleged false claims. This year saw increased participation from state Medicaid units compared to previous years, with 90 of the accused being doctors or other licensed medical professionals. The DOJ emphasizes that these charges are still subject to proof in court.
Many of these schemes exploited individuals’ medical identities. Prosecutors also pursued aggravated identity theft charges across numerous states. In one notable case, the co-owner of a mental health company in Virginia is accused of paying homeless individuals with hotel stays, subsequently using their Medicaid numbers to bill Medicaid for crisis services that were never rendered to the patients.
While the legal cases may eventually close for the victims whose identities were used, rectifying their medical records can be a far more complex and lengthy process. Once another person’s treatment is recorded under your name, it can introduce inaccurate information into your medical chart. This can also deplete insurance benefits that you might need in the future, a problem that is significantly harder to resolve than canceling a compromised credit card.
DR OZ WARNS MEDICARE SCAMMERS ARE STEALING BILLIONS — AND YOUR PERSONAL INFORMATION COULD BE NEXT
According to the Federal Trade Commission (FTC), medical identity theft occurs when an individual’s name, Social Security number (SSN), health insurance account number, or Medicare number is used by someone else to obtain medical services, fill prescriptions, purchase medical equipment, or submit fraudulent claims.
When medical services are billed under your identity, the thief’s health information can become intertwined with yours. The FTC warns that such mixed records can negatively impact the quality of care you receive and the benefits you are entitled to. A blood type, a drug allergy, a diagnosis, or a prescription that belongs to a stranger could be present in the medical file a physician consults before providing you with treatment.
Healthcare providers and insurance companies maintain the precise records that facilitate these fraudulent activities, and these records are frequently compromised. It is important to note that not every healthcare data breach inevitably leads to identity fraud. However, this explains why your insurance number, Medicare number, SSN, and medical records can retain significant value long after a breach notification has been issued.
This past spring, NYC Health + Hospitals disclosed that an unauthorized intruder had accessed and copied files that potentially contained health insurance information, medical data, biometric data, billing information, and other personal details. This breach was later reported to have affected approximately 1.8 million current and former patients and employees.
Once sensitive information such as a name, SSN, insurance number, Medicare number, or medical record enters the criminal marketplace, it can be resold to individuals or groups who then use it to submit fraudulent claims under someone else’s identity.
The FTC recommends safeguarding your health insurance and Medicare numbers with the same level of caution you would exercise for a payment card, as these are the primary targets for such operations.
HOSPICE FRAUD USES STOLEN IDENTITIES FOR FAKE PATIENTS
Because fraudulent medical claims are processed through insurance and provider systems rather than credit checks, they bypass the alerts that most individuals rely on to detect suspicious activity.
The FTC advises vigilance for the following signs:
If you receive a bill, Explanation of Benefits (EOB), or Medicare notice detailing services you never received, it is crucial to act promptly and maintain all communications in writing.
Contact your insurer or Medicare using the official phone number found on your insurance card, and avoid using numbers provided in unsolicited texts, emails, or voicemails.
When you contact your insurer or Medicare, inquire about the provider’s name, the date of service, the claim number, and specific details about the services rendered.
Reach out to the healthcare provider in writing and request access to the medical or billing records associated with the fraudulent claim.
Report the discrepancy to the fraud department of your insurance provider.
If your medical identity has been compromised, file a report at IdentityTheft.gov. This will provide you with a recovery plan and essential documentation that may be required if fraudulent bills or collection notices appear later.
Keep meticulous records of every bill, EOB, letter, portal message, police report, and case number related to the incident.
Request your medical records from every provider, clinic, pharmacy, laboratory, and insurer that the identity thief might have used. Subsequently, report each inaccuracy in writing. Under the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers are generally required to provide access to your records within 30 days of a written request, with a potential 30-day extension.
The process of correcting your medical records can be more time-consuming. The Department of Health and Human Services (HHS) indicates that healthcare providers or health plans typically have up to 60 days to act on a request to amend a medical record, with a possible 30-day extension under specific circumstances. If the provider or plan was responsible for creating the erroneous information, they are obligated to amend inaccurate or incomplete details.
However, there is a potential complication: a provider may refuse to release records that now contain a stranger’s information, citing that individual’s privacy rights. If this occurs, request to speak with the provider’s privacy officer or a patient advocate. You also have the option to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights if you do not receive your records or a satisfactory explanation within the stipulated timeframe.
TEXAS DATA BREACH HITS 3M LICENSE CUSTOMERS
While a credit freeze can prevent the opening of new accounts, it offers no protection against fraudulent claims filed using your insurance number. Given that medical identity theft can occur without affecting your credit file, monitoring where your personal information appears is the most effective initial step to address it.
An identity theft protection service can monitor the dark web, data broker sites, and people-search websites for exposed SSNs, driver’s license numbers, medical ID numbers, and email addresses. It can also track all three credit bureaus for any medical collections that may arise and flag changes in public records associated with your name.
Should misuse be detected, some services offer fraud resolution support to assist you in requesting records, disputing fraudulent claims, and liaising with providers, insurers, and credit bureaus. Certain plans also include identity theft insurance to cover eligible recovery expenses.
No service can guarantee complete prevention of all medical identity misuse. However, continuous monitoring can help identify exposed information before another person’s medical treatment is inaccurately attributed to your records and your insurance.
For my tips and best picks on identity theft protection, visit CyberGuy.com.
Medical identity theft impacts a place that most of us rarely scrutinize: our health records. A stolen credit card can typically be canceled quickly. However, a compromised Medicare or insurance number can lead to fraudulent claims, incorrect diagnoses, and benefit-related complications that persist long after the fraud case is resolved. It is advisable not to wait for a credit alert in such situations. Regularly review your EOBs, Medicare Summary Notices, and insurer portals for any visits, prescriptions, or equipment you did not receive. Furthermore, treat your insurance card with the same security as a payment card. Do not share your number with unsolicited callers, texters, or emailers offering freebies. The most critical action is to respond swiftly. Contact your insurer or Medicare, request detailed claim information, and formally request your medical records in writing. Subsequently, file a report at IdentityTheft.gov to ensure you have the necessary documentation in case fraudulent bills or collection notices emerge.
Have you ever noticed a medical bill, insurance claim, or EOB for services you never received? Please share your experience by writing to us at CyberGuy.com.
