Kathleen G. Kane - Pennsylvania Office of Attorney General - Protecting Pennsylvanians

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ASK THE ATTORNEY GENERAL: How Can I Protect My "Medical" Identity?

Most consumers are familiar with the threat of becoming a victim of financial identity theft.  However, medical identity theft is a new form of stealing your identity that consumers may not be aware of.  This type of identity theft does not require a lot of skill and may go undetected for a long period of time, making it extremely appealing to criminals.

What is Medical ID Theft?

Medical identity theft occurs when an individual uses another person's medical benefits or prescription drug card information to receive medical services or drugs. Scam artists are not the only perpetrators of medical identity theft.  Unfortunately, these crimes can also be committed by organized crime rings, doctors, psychiatrists, nurses, hospital, and lab employees. Often times the crimes result from a person being on the "inside" who has access to another person's medical information. Examples of how your medical identity may be used illegally include:

  • Someone seeking specialized or serious medical treatment or surgery, who cannot afford the care, is uninsured, underinsured or just doesn't want to pay for health care.
  • Someone obtaining routine medical services, check-ups, X-rays or exams at a hospital, doctor's office or medical center.
  • Someone seeking lab tests.
  • Someone seeking prescription drugs for personal use or to sell illegally.
  • Someone filing a false insurance claim who never received any drugs or services.

Medical identity theft is dangerous not just because a person's medical information is used without their knowledge, but because their actual medical history and records may be altered as a result of the unauthorized use. A victim of this form of ID theft may not know that their medical records have been hijacked to reflect the medical condition of the thief who stole your identity. This becomes particularly dangerous if you need emergency care at a hospital and you have a different blood type than what is reflected on your records. Any erroneous information in your health records creates a serious risk to the care you might receive if you need to seek treatment and could affect your ability to obtain health or life insurance in the future. 

What can I do to protect myself from becoming a victim of medical ID theft?

Medical identity theft is not as easy to detect as financial ID theft, which in some cases can be discovered quickly should an unauthorized charge appear on your credit card. To help protect your medical identity, I recommend that consumers:

  • Refrain from carrying around their Social Security card or information that contains their social security number.
  • Do not leave their medical benefits or prescription drug cards unattended in a purse, locker or desk.
  • Never give out their financial, health or insurance information to telemarketers, unsolicited salespeople or strangers. 
  • Always check their "explanation of benefits" notices that are sent from medical providers.  Look for services that were never performed, incorrect dates of treatment or services, prescriptions that were never ordered and medical equipment or services that they did not receive. Any suspicious entries should be reported immediately.
  • Ask their insurer, at least once a year, for a list of all benefits that have been paid in their name. Sophisticated criminals will change the consumers' billing address and phone number so the victims remain unaware that the benefit has been paid in their name.
  • Check with their local pharmacists to see if any prescriptions have been filled in their name without authorization. 
  • Request an accounting of disclosures from their health care providers. Many consumers do not realize that under HIPAA, the Health Insurance Portability and Accountability Act, they have the right to obtain these records.
  • Obtain copies of their medical files from each health care provider so records can be reviewed to see if any information is inaccurate or suspicious.  Providers are allowed to charge copying costs so discuss the charges in advance.
  • Correct erroneous information in their medical file by requesting to "amend" their health care records and request the removal of false or inaccurate information.
  • Monitor their credit report to ensure that they have not been reported to a credit agency for failing to pay a debt that they didn't know about.

What should I do if I am a victim of medical ID theft?

Contact the Attorney General's Office and your local police department to report and document the criminal activity.  I would also recommend that you contact your health insurer, credit bureaus, banks and other financial institutions. If you suspect that you have been the victim of Medicare/Medicaid fraud, call 1-800-HHS-TIPS (1-800-447-8477.