Medical identity theft occurs when someone steals your personal information such as date of birth, Social Security number, health insurance identification number, and Medicare number with the intent to use the unauthorized information to obtain medical care, services, or medical payments in either your name or someone else’s name, such as fraudulently obtaining prescription medications and medical devices or submitting false medical bills to health insurance companies or Medicare in order to receive unjustified medical payments. Medical identity theft affects not only the persons from whom medical care and services were fraudulently obtained, but also the people whose medical identities were stolen.
Medical identity information can be wrongfully obtained by many means including from unscrupulous medical billing personnel who have legitimate access to the information as part of their job responsibilities but then they sell or otherwise provide the information to third-parties who use the information for illegal purposes, from people who rummage through other people’s trash and discarded papers that are left on the curbside for municipal trash or recycling pick up, and from people who may be sitting in hospital waiting rooms or other medical offices who simply eavesdrop on people who provide their personal information to the hospital or medical office staff. There are even individuals and organized groups who may approach people leaving medical appointments or in parking lots who offer to buy their personal medical identification information for the purpose of committing medical fraud. There are some companies that offer “free” medical equipment or services but then request Medicare numbers or health insurance information in order to bill the government programs.
There are steps that can be taken to reduce the possibility that you will become the victim of medical identity theft. Guard your Social Security and Medicare numbers as if they were cash — don’t give them to anyone without knowing who is receiving the information and that there is a legitimate reason for obtaining the information (don’t be fooled by telemarketers or Internet websites that request your Social Security number or Medicare number). Under no circumstance allow anyone to “borrow” your Social Security number, your Medicare number, or your health insurance information. Documents and papers that contain any of your personal information should be thoroughly shredded before being discarded or recycled.
When you receive Medicare Summary Notices or Explanation of Benefits notices from Medicare or your health insurance, review them carefully to make sure that you were not charged for services or medical equipment that you did not receive, that the dates of services and the names of the service providers are familiar to you and are correct, and that you were not double-billed for services or medical equipment.
If you have a question regarding any charge, contact your health care provider to obtain an explanation (health care providers and their staff sometimes do make mistakes). If the explanation provided to you does not make sense or is inadequate and the charge was billed to Medicare, contact Medicare (800-633-4227 or www.medicare.gov). If the questionable bill was submitted to your health insurance, contact your health insurance promptly (the Explanation of Benefits forms that you receive from your health insurance usually have a contact telephone number to report a suspicious or questionable bill). If your identity is stolen or misused, immediately report it to the Federal Trade Commission’s Identity Theft Hotline (877-438-4338 or www.FTC.gov/idtheft).
Medical identity theft costs millions of dollars each year in losses sustained by Medicare and private health insurance. Money diverted to pay swindlers is money that is unavailable to pay for necessary medical care. Insurance rates may have to be increased to offset money obtained illegally. Someone using your medical identity to obtain medical care and services in your name may result in damage to your credit rating and may even result in life-threatening consequences if the wrong information ends up in your medical records (for instance, if someone uses your medical identity to obtain treatment in your name for diabetes, which you do not have, a medical provider reviewing your medical records while treating you may provide inappropriate medications or treatment (or fail to provide appropriate medications or treatment) because your medical records erroneously document you as a diabetic).
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