Preventing Medical Identity Theft

The latest form of identity theft could not only cost you money - it could also cost you your life. We spoke with Pam Dixon, the director of the World Privacy Forum, to find out more about medical identity theft and how to spot it.

What Is Medical Identity Theft?

Medical identity theft occurs when a person(s) assumes the identity of another individual in order to make false insurance claims, receive insurance benefits or obtain medical care or goods.

While financial identity theft has monetary implications, medical identity theft could result in incorrect information found in medical records or creating additional medical records in the victim’s name. Unfortunately, this incorrect information could remain unnoticed for quite sometime and potentially influence future medical care for the victim.

What Can I Do To Prevent Medical Identity Theft?

Insurance Benefits and Security

  1. Take care with your insurance policy and health care provider papers, bills, statements, receipts, insurance cards – anything that has your personal data, financial, and health information on it. Treat your health information like you would your credit card information.
    • Instead of throwing away documents, use a cross-cut shredder to shred papers that list your account numbers or personal information.
  2. Many insurance companies use your social security number as your identification number for policies. You may want to change this. Contact the insurance company to see if it is possible to change the number to an alternate number.
  3. Get in the habit of reading every insurance bill or statement sent to you. Read it carefully, even if it says “This is NOT a bill.” Look for services, care or goods that you may not have received.
    • If you have a question about your insurance bill, call your insurance company’s special investigations department. Most insurance companies offer toll-free numbers for you to call.
    • When calling, be sure to have your insurance card and the statement or bill with the error, on hand. You may also need to provide your name, phone number, social security number and billing address. Also, be prepared to explain the suspected problem in detail.
  4. Every year, request a listing of all the insurance benefits paid under your name. This may also be referred to as “accounting of disclosures.” According to the World Privacy Forum, one common tactic identity thieves use is to change your billing address and phone number without your knowledge. So be proactive, contact the insurance company directly and ask to receive a year long listing of the benefits paid.
    • To learn more about how to request this information, read the World Privacy Forum’s tips on medical identity theft.

Medical Records and Statements

  1. Keep your own medical history for yourself and your family.
    • Keep track of all contact details for doctors, pharmacists, dentists and other health care providers. It’s hard to remember all past illnesses, medications, immunizations, allergies and names of each provider seen.
    • Also, having this original copy may help in a medical identity theft situation.
  2. Get in the habit of reading every medical bill or statement sent to you. Read it carefully, even if it says “This is NOT a bill.” Look for services, care or goods that you may not have received.
    • If you have a question about a bill from a health care provider, contact their billing department.
    • When calling, be sure to your insurance card and the statement or bill with the error, on hand. You may also need to provide your name, phone number, social security number and billing address. Also, be prepared to explain the suspected problem in detail.
  3. Every year, request an “accounting of disclosures” from your health care providers. According to the World Privacy Forum, one common tactic identity thieves use is to change your billing address and phone number without your knowledge. So be proactive, contact the health care provider directly and ask to receive a year long listing of your disclosures.

Privacy Rights and HIPAA

  1. Learn about your privacy rights. You may have heard of the word “HIPAA.” HIPAA stands for the Health Insurance Portability and Accountability Act, which is an act that regulates the privacy of health information. Under HIPAA, medical records are kept private under certain circumstances but not all.
  2. Remember, many victims don't notice the identity theft until years down the line, according to the World Privacy Forum’s report. Why not look now at past statements and bills you may have kept? Also, take precautions now and keep a watchful eye over the security and accuracy of your future records, statements and bills.

What Should I Do If I Suspect Medical Identity Theft?

  1. Start a folder for your records. Keep copies of all suspected documents.
  2. Also, start a notebook. Document all conversations including the date, contact name, title, organization, topics discussed and next actions to be taken.
  3. If something doesn’t sound right – for example, a mention of a past service that’s listed in your medical records – ask about it. You should also request to see a copy of your medical records and you should also try to get your records amended.
    • For more information or if you are having trouble filing a request, visit the World Privacy Forum and read their detailed report on medical identity theft.
  4. Notify your health insurance company and health care providers. Tell them what you’ve noticed and ask to verify any benefits paid out with them.
  5. Be proactive. Don’t wait for the company or healthcare provider to contact you. Be sure to follow up.

Additional Resources

  • Most insurance companies offer information on healthcare fraud and medical identity theft. Visit their Web site or call their customer service line for more information
  • Privacy Rights Clearinghouse
    The Privacy Rights Clearinghouse (PRC) is a nonprofit consumer organization with a two-part mission: consumer information and consumer advocacy.
  • World Privacy Forum
    The World Privacy Forum is a nonprofit, non partisan 501 (C) (3) public interest research group. The organization is focused on conducting in-depth research and consumer education in the intersecting areas of technology and privacy.

Updated: 5/2009