Medical Identity Theft - Danger & Detection

Medical identity theft is when someone has used your personal information, unbeknownst to you, in order to receive medical treatment, prescriptions, or even payments from insurance.  This is likely the most dangerous form of identity theft because if you are a victim of medical identity theft, you could well discover that your medical records contain inaccurate information, which can severely impact your capability to receive accurate medical care and insurance benefits.  Suppose you are diabetic and the identity thief is not.  What happens if you are in the hospital and do not receive proper treatment for diabetes?  What if you are in a situation where you must receive a blood transfusion and the identity thief has a different blood type than you?

An actual case of medical identity theft happened to a mother of 3, with her youngest being 5 or 6 months old.  She received a phone call from a hospital to inform her that her newborn had tested positive for crack cocaine.  The lady laughed it off as someone calling who was confused.  Three days later, the seriousness and reality of the situation set in when Child Protective Services knocked on her door threatening to remove her children from the home because of drug use. 

Vigilance is the best way to detect medical identity theft early.  A few of the steps you can take in order to stay aware are to:

• Carefully review every Insurance Explanation of Benefits you receive from your health insurance provider and ensure that the dates, treatments, and any other pertinent information are correct.  Should something appear that is incorrect, contact your insurance provider or the healthcare provider listed and question the statement.  If anything appears wrong, raise questions with the insurer or the provider.
• At a minimum, annually request a list of benefits paid in your name by your health insurance provider(s).  Again, make sure the itemization matches any treatments or prescriptions you have received and question anything that appears incorrect. 
• Monitor your credit reports with the nationwide credit reporting companies – Equifax, Experian, and/or TransUnion – to see if any medical debts appear.

Correcting inaccurate medical records can be quite difficult, however, federal law provides you rights that can assist you in correcting inaccurate medical records. They include, but are not limited to the following:

• The right to have your medical records amended to remove inaccurate or incomplete information.
• The right to a record of who has been given access to your medical records, such as health care providers and health insurers. This information is valuable in being able to track down where inaccurate information could have been sent.
• The right to request copies of your current medical files from each health care provider.
• The right to file a complaint with the Office of Civil Rights at the federal Department of Health and Human Services if a health care provider does not comply with these rights. Many hospitals also have ombudsmen or patient advocates who might be capable of helping you get your medical records or at least get you access to the information.

For more information about your rights regarding medical identity theft and inaccuracies in your medical records, you can  www.hhs.gov/ocr/hipaa.