Fake claims can drain your benefits and put someone else’s medical history in your file
When you spend days or weeks on the road, a strange medical bill or insurance notice can be easy to miss. Yet one claim for care you never received could mean someone is using your health insurance, Medicare number or Social Security number (SSN).
The Justice Department recently charged 455 people in its annual National Health Care Fraud Takedown. The cases involve more than $6.5 billion in alleged false claims. More state Medicaid fraud units participated than in any previous year, and 90 of the accused are doctors or other licensed medical professionals. Prosecutors still must prove the charges in court.
Many of the alleged schemes relied on other people’s medical identities. Prosecutors also filed aggravated identity theft charges in cases across dozens of states. In one case, the co-owner of a Virginia mental health company allegedly paid homeless people with hotel stays, used their Medicaid numbers and billed for crisis services they never received.
For a truck driver, the damage could surface during a doctor or emergency room visit hundreds of miles from home. Someone else’s diagnosis, prescription or treatment may appear under your name. Fake claims can also use up insurance benefits you may need later. That can be much harder to fix than canceling a stolen credit card.
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The identity thief’s treatment gets written into your file
Medical identity theft happens when someone uses your name, SSN, health insurance account number or Medicare number to see a doctor, fill a prescription, buy medical equipment or submit a claim, according to the Federal Trade Commission (FTC).
When care is billed under your name, the thief’s health information can blend into yours. The FTC warns that mixed records can affect the care you’re able to get and the benefits you are able to use. A blood type, a drug allergy, a diagnosis, or a prescription that belongs to a stranger can sit in the file a physician reads before treating you.
Data breaches can feed the market for medical identity theft
Hospitals and insurers hold the exact records that make the fraud work, and those records are stolen often. This does not mean every health care breach leads to fraud. However, it explains why your insurance number, Medicare number, SSN and medical records can become valuable long after a breach notice arrives.
This spring, NYC Health + Hospitals reported that an intruder had copied files that may have included health insurance information, medical information, biometric data, billing data and other personal information. The breach was later reported to affect roughly 1.8 million current and former patients and employees.
Once a name, SSN, insurance number, Medicare number or medical record reaches a criminal marketplace, it can be resold to operators who bill under someone else’s identity.
Treat your insurance card like a credit card
Your health insurance and Medicare numbers are what these operations need, so the FTC recommends guarding them the way you would a payment card.
- Keep enrollment forms, benefit statements, and prescription labels somewhere secure, and shred them before throwing them out.
- When a doctor’s office asks for your SSN, ask whether it can use another identifier or the last four digits instead.
- Be wary of anyone who calls, texts, or emails offering free braces, genetic tests, or medical supplies in exchange for your Medicare number; several of the schemes in the June takedown billed Medicare for exactly those items.
- If you are on Medicare, create or log in to your secure Medicare account and review your claims. You can also check your Medicare Summary Notice for services, supplies or equipment you do not recognize. If something looks wrong, call 1-800-MEDICARE.
Your credit report may never flag this fraud
Because a fraudulent medical claim runs through insurance and provider systems instead of a credit check, it skips the alerts most people rely on.
Here’s what the FTC says you should look out for:
- A bill or an Explanation of Benefits (EOB) statement for care you never received;
- A call from a debt collector about a medical debt you do not owe;
- A medical collection you do not recognize on your credit report;
- A notice from your insurer that you have reached your benefit limit; or
- A Medicare Summary Notice that lists services, supplies or equipment you never received.
What to do first if a medical claim looks wrong
If a bill, EOB or Medicare notice shows care you never received, move quickly and keep everything in writing.
1) Call your insurer or Medicare directly.
Call your insurer or Medicare using the number on your card — do not call a number from a random text email or voicemail.
2) Get the claim details.
Ask for the provider’s name, date of service, claim number and service details.
3) Request the records in writing.
Contact the provider in writing and request the medical or billing records tied to that claim.
4) Report the error.
Report the error to your insurer’s fraud department.
5) File an identity theft report.
File a report at IdentityTheft.gov if your medical identity was used. That gives you a recovery plan and documentation you may need if fraudulent bills or collections show up later.
6) Save every document.
Keep copies of every bill, EOB, letter, portal message, police report and case number.
Correcting a medical file is slower than disputing a charge
Request your records from every provider, clinic, pharmacy, lab and insurer the thief may have used, then report each error in writing. Under HIPAA, a provider generally has 30 days to give you access to your records after a written request, with a possible 30-day extension.
Fixing the record itself can take longer. HHS says a covered provider or health plan usually has up to 60 days to act on a request to amend a medical record, with a possible 30-day extension in certain cases. If the provider or plan created the wrong information, it must amend inaccurate or incomplete information.
There’s one catch, though: A provider may refuse to release records that now contain a stranger’s information, citing that person’s privacy. If that happens, ask for the provider’s privacy officer or patient advocate. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights if you do not get your records or an explanation within the required window.
A credit freeze alone won’t stop a claim under your insurance
A freeze blocks new accounts, but it does nothing about a claim filed with your insurance number. Because medical identity theft can move without touching your credit file, monitoring where your personal information appears is the earliest way to act on it.
A comprehensive identity theft protection service can monitor the dark web and hundreds of data broker and people-search sites for exposed Social Security numbers, driver’s licenses, medical ID numbers and email addresses, alerting you if your information is found. Many services also monitor all three major credit bureaus for suspicious accounts or collections, track public records for unexpected changes tied to your identity, and provide access to U.S.-based fraud resolution specialists who can help request records, dispute fraudulent claims and work with healthcare providers, insurers and credit bureaus if your identity is misused. Some plans also include identity theft insurance to help cover eligible recovery costs.
No service can prevent every misuse of your medical identity. Continuous monitoring may flag your exposed information before another person’s treatment reaches your records and your insurance.
See Kurt’s tips and best picks on Best Identity Theft Protection at Cyberguy.com/IdentityTheft.
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Kurt’s key takeaways
Medical identity theft can be especially easy to overlook when you spend long stretches on the road. Insurance letters may pile up at home, while unfamiliar claims sit unnoticed inside an insurer or Medicare portal.
Do not wait for a credit alert, because many fraudulent medical claims never trigger one. Make a habit of reviewing your EOBs, Medicare Summary Notices and online insurance claims for appointments, prescriptions or medical equipment you never received.
Also, protect your insurance card the same way you protect a credit card. Never give your insurance or Medicare number to someone who contacts you unexpectedly with an offer for free medical supplies, braces or testing.
When you find a suspicious claim, call your insurer or Medicare using the number on your card. Ask for the provider, date of service, claim number and treatment details. Request the related medical records in writing, report the fraud and file a report at IdentityTheft.gov. Acting quickly may help stop another person’s medical history from becoming part of yours.
Truckers, how often do you check your health insurance claims while you are on the road, and have you ever found a charge you did not recognize? Let us know your thoughts by writing us at Cyberguy.com/Contact.
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Kurt’s a curious guy. Like many entrepreneurs in life, he wears several hats like running a private investment fund, giving inspirational talks, mentoring start-ups and traveling the world chasing down the next breakthrough.
