Medical Identity Theft

When personal information, such as insurance or Social Security, is used to obtain medical services or products, Medical Identity Theft occurs.  It is also Medical Identity Fraud is another's identity is used in the pursuit of false medical claims or records.

One of the most financially taxing forms of Identity Theft, Medical Identity Fraud affects the victim, or individual whose identity is being stolen, as well as health care, including the Medical Providers and Insurance Agencies involved.

Medical Identity Theft is a misunderstood form of Identity Theft.  It is a mixture of the Financial Fraud, Identity Theft and Health Care Fraud.  This may include:

• False Medical Records for Treatment Not Received (Usually to Submit Insurance Bills for Reimbursement)
• False Prescriptions Picked-Up by Another Entity
• Using Another Individual's Name to Utilize Their Health Insurance

Medical Identity Theft Protection - HIPAA
The Health and Insurance Portability and Accountability Act of 1996 (HIPAA) passed regulations to support the privacy of health records and the identities held within them.  Effective in 2003, HIPAA gives individuals the rights over their own Personal Health Records.  This act was put into action to protect people and prevent Medical Identity Theft.  This law applies to recorded private information, such as:

• Information Logged in Your Medical Records by Health Care Providers
• Treatment or Care Recommendations by Your Doctor
• Personal Information Kept by Your Health Insurer
• Hospital/ Clinic Billing Information

Multi-platform health providers must follow this law, including Hospitals and Staff, Pharmacists, Health Insurers, including most Employer Group Health Plans as well as Medicare and Medicaid.  What HIPAA means to you:

• See/ Receive a Copy of Your Personal Health Records
• Correct Your Personal Health Records
• Authority Over the Release of Your Personal Health Records (for Marketing or Other)
• Receive a Statement Discussing How Your Personal Health Records May Be Used/ Shared
• Receive a Report Discussing How/ When/ Why Your Personal Health Records Was Shared

How to Protect Yourself from Identity Theft >>>

Medical Identity Theft Prevention
While there is not a single company to collect Medical Information, such as Experian for credit reporting, there are a few steps to take for the prevention of Medical Identity Fraud.  Recommended tips include:
Obtain a copy of the HIPAA Health Privacy Rules

• Keep Your Medical Records for Revue
  o You should not be charged for Inspecting Your Records, however, you may be charged a Fee for Copies.
• Pay Attention and Read Your Statements:
  o Health Insurance Information for Services Not Requested By You
  o Receipt for Services You Did Not Use
  o Debt Collection for Unwarranted Health Care Bills
  o Preserve Your Rights and Ask Questions

Victims of Medical Identity Theft
When you have become a victim of Medical Identity Theft, we can help.

If you believe you are a victim of Medical ID Fraud, obtain personal records from relevant physicians or clinics.  Be prepared to request dated records, sometimes going back months or even years.  Think relative to the clues you gather pertaining to Medical Identity Theft.

The World Privacy Forum recommends that any victim of Medical Identity Theft to be friendly yet determined, in explaining clearly to your medical institution the reasons behind your request.  Also, be prepared for the unexpected.  It is possible that the thief used doctors/health care providers that you do not even know about.

Lastly, it is also important to obtain a copy of your credit report as the criminal may have made illegal charges beyond Health Care.

Victim of HIPAA Non-Compliance
If you feel that your rights have not been met under the law of HIPAA:

• If you need to file an Administrative Complaint with the Department of Health and Human Services, go to:
  o http://www.hhs.gov/ocr/privacyhowtofile.htm
• File a complaint with your Health Provider or Health Insurer
• File a complaint with the U.S. Government

Contact a CITRMS Professional today to protect your business from Medical Identity Theft.