During the ongoing national debate over healthcare reform, there is one point most people can agree on: the need to curtail the growing epidemic of healthcare fraud. Estimates put the loss at $65 billion a year to Medicare alone. Government agencies are working hard to catch these crooks—and you can help by protecting yourself and loved ones against medical identity theft.

Medical identity theft happens when a scammer steals your personal information (such as your name, Social Security number and medical insurance policy and/or Medicare number) and uses it to commit healthcare fraud.

Once crooks have your personal information, what could happen? A thief could walk into a hospital and use your name and identity to obtain medical treatment or drugs. Or, an unscrupulous provider (or a dishonest employee of an honest provider) could file fraudulent charges in your name. Criminals have even formed phony “clinics” using post office boxes to cheat insurance companies by filing fraudulent medical claims.

Medical ID theft can have an impact on…

1. Your money. You could be billed for the thief’s charges, and possibly end up spending even more for legal help to straighten out the problem.
2. Your credit rating. Unpaid charges run up by the crooks can impact your credit score.
3. Your time. It can take many hours to untangle the mess, which might involve one or more of your healthcare providers, your insurance company and/or Medicare, the credit bureau, even law enforcement agencies.
4. Your good name. Some victims have found themselves involved in a criminal investigation when scammers illegally obtain drugs in their name.
5. Your health. Most importantly, Medical ID theft could be dangerous if the criminal’s information (blood type, medical history, medications, allergies, etc.) were to be entered in your medical records. And if a thief uses up your insurance benefit cap, you could be denied coverage for treatment when you need it, or even lose your coverage.

And beyond the personal level, medical ID theft hurts us all by helping to drive up medical costs across the nation.

Fortunately, there are steps you can take to avoid medical ID theft. Know the warning signs, and be proactive in protecting your personal information.

• Protect your insurance and Medicare information just like you do your ATM card, credit card number and Social Security number. Don’t divulge the information to anyone except your healthcare provider’s office, insurance company, Medicare, or your State Health Insurance Assistance Program (SHIP).
• Report a lost or stolen card to your insurance company or Medicare right away.
• Always review medical bills, insurance explanation of benefits statements and Medicare summary notices. Be alert for unexpected or unexplained charges for medical services or purchases.
• Ask your healthcare provider for a copy of your medical records. (There may be a fee for this; you probably don’t need copies of more expensive items, such as X-rays.)
• Review your credit report once a year. Many times, especially if scammers have been careful to cover their tracks, this will be the first place a problem shows up.
• Thieves sometimes change a victim’s contact information when obtaining services. So even if you’ve been reviewing your monthly statements, each year request that your insurance company send a comprehensive list of all benefits paid.
• If a salesperson calls and asks you to divulge your insurance or Medicare information, hang up. A reputable salesperson will never ask for your personal data.
• Don’t deal with a salesperson who offers “free” products or says he can help you “get around” Medicare laws.

If you suspect you’ve been victimized:

• Contact your healthcare provider if you see a questionable charge in medical bills, insurance benefits statement, or Medicare summary and think it might be a mistake. (Sometimes legitimate charges from a medical test or procedure will come from a different entity whose name may be unfamiliar to you.)
• If you suspect someone has used your medical ID, contact your insurance company right away. If you have Medicare, see the resources at the end of this article for contact information. File a police report, and contact the Federal Trade Commission.

The World Privacy Forum estimates that fraud accounts for up to 10% of all American health care costs! But since most Medicare and insurance fraud relies upon stolen personal information, you can be part of the solution. By spending a few minutes reviewing your information, you can help put a stop to a scammer’s illegal activities.

For More Information

If your Medicare card is lost or stolen, call 1-800-MEDICARE (1-800-633-4227). If you suspect fraud, call 1-800-447-8477 or email hhstips@oig.hhs.gov. Visit the Medicare site for more information about fraud and for help with reading your Medicare Summary Notice. Visit the Stop Medicare Fraud website  for more information, including an easy-to-understand factsheet.

The Federal Trade Commission offers information on Medical Fraud and how to file a report if you suspect fraud.

The World Privacy Forum offers tips for preventing Medical Identity Theft, and a detailed tutorial about what consumers should do if they suspect they have been a victim of Medical ID theft.

Copyright © IlluminAge AgeWise, 2011