Responding to Patient Medical Identity Theft & Healthcare Fraud

 

Responding to Patient Medical Identity Theft & Healthcare Fraud

Medical identity theft and healthcare fraud; it’s a growing problem that can wreak havoc on your finances, insurance, medical history, and more. As a patient, it’s downright scary to think someone could steal your identity and rack up medical bills in your name. So what can you do to protect yourself and respond if you suspect you’re a victim? Let’s break it down.

Watch for Red Flags

Be proactive and keep an eye out for any suspicious activity that could indicate medical ID theft or fraud. Here’s what too look for:

• Medical bills for services you didn’t receive
• Insurance claims for care you didn’t get
• Collection calls or bills for medical debt you don’t owe
• Denials for healthcare coverage due to maximum benefits being reached
• Medical records showing health conditions you don’t have
• Prescriptions or medical supplies you didn’t order sent to your house

If you notice any of these red flags, it’s time to start investigating. Don’t ignore it and hope it goes away!

Review Your Medical Records

Request copies of your medical records from all healthcare providers you’ve seen over the past few years. Carefully review them, on the lookout for any suspicious or fraudulent activity. Some things to check for:

• Services, procedures, or diagnoses you don’t recognize
• Inaccurate personal/insurance information
• Forged signatures on forms
• Multiple records under different names

If you spot discrepancies, ask for a corrected copy of your file. This creates a paper trail documenting the errors.

Check Your Credit Report

Order free credit reports from Equifax, Experian, and TransUnion. Verify all accounts are legitimate. Watch for medical collections or debts you don’t recognize, as that’s a sign your identity was misused. Dispute any fraudulent accounts immediately and have them removed. Here’s how to dispute credit report errors.

Review Health Insurance Claims

Call your health insurer and ask for an audit of all recent claims made in your name. Closely examine the provider names, dates of service, procedures performed, etc. Report any claims for services you didn’t receive. This helps establish a timeline of when the fraud occurred.

File Police Reports

File reports with both your local police department and the FBI’s Internet Crime Complaint Center (IC3). Provide copies of records showing fraudulent activity. This creates an official paper trail and law enforcement can aid investigations.

Report to Federal Agencies

Notify these agencies about the identity theft:

• FTC – Report via IdentityTheft.gov
• U.S. Department of Health and Human Services Office of Inspector General (oig.hhs.gov)
• CMS Fraud Prevention Hotline (1-800-MEDICARE)

File detailed complaints and submit evidence of the fraud when possible. These agencies can pursue cases against perpetrators.

Contact Healthcare Providers

Inform any provider whose name or information was used fraudulently. Ask them to correct your records and flag your file to prevent future misuse. Provide a copy of the police report.

Monitor Your Accounts

Keep a close eye on medical bills, insurance claims, and credit reports moving forward. Dispute any fraudulent activity immediately. Sign up for credit monitoring if identity theft protections are offered. Act quickly to minimize damages.

Correct Your Medical Records

Have any false information removed from your medical files. Submit statements detailing what is inaccurate and needs correcting. Ask providers to include your statement in the corrected record. This prevents errors from impacting future care.

Place a Fraud Alert

Contact one of the three credit bureaus to place an initial 90-day fraud alert on your accounts. This requires creditors to verify your identity before opening new accounts. You can renew the alert after it expires. Here’s how to request fraud alerts from each bureau:

• Equifax
• Experian
• TransUnion

Consider a Credit Freeze

For stronger protection, place a credit freeze restricting access to your credit reports. This blocks new accounts from being opened. You’ll have to lift the freeze temporarily when applying for credit or services yourself. Here’s how to request freezes:

• Equifax
• Experian
• TransUnion

Watch For New Accounts

Keep monitoring your credit reports moving forward for signs of new fraudulent accounts. Dispute them right away to minimize damage. Consider signing up for credit monitoring services for added protection.

Change Account Passwords

If you suspect someone illegally accessed your accounts, change the passwords immediately. Make them strong and unique for each account. Enable two-factor authentication when possible.

Review Explanation of Benefits

Carefully read all insurance explanation of benefits statements when received in the mail or online. Verify all claims are for services you actually received. Report any discrepancies to your insurer’s fraud department right away.

Watch For Errors in Your Medical Records

Always review your medical records from each provider for accuracy. Make sure test results and health data are correct. Look for mistakes introduced by identity theft and fraud. Request corrections immediately.

Learn From the Experience

While no one wants to be a victim of fraud, dealing with it can make you savvier. Going forward, opt for electronic statements over paper to deter theft. Shred documents with personal information before discarding. Use strong unique passwords for all accounts. Remain vigilant about reviewing your records and reports. Being proactive is your best defense.

Dealing with medical identity theft and healthcare fraud can be challenging. But following these steps helps protect yourself and limit the damage. Don’t hesitate to reach out to providers, agencies, and law enforcement. And remember to breathe – you’ve got this!

References

FTC: What to Know About Medical Identity Theft
Experian: Medical Identity Theft: Protect Yourself from this Growing Form of ID Theft
AARP: How to Prevent Medical Identity Theft
IdentityForce: Medical Identity Theft: Everything You Need to Know
FTC: Disputing Errors on Credit Reports
FTC: What to Know About Credit Freezes and Fraud Alerts