What Is Medical Identity Theft?

Identity thieves don’t limit themselves to your credit cards and bank accounts. Medical identity theft happens when a criminal uses your personal information—such as a Social Security number, Medicare number, or health plan ID number—to receive medical care, or falsely bill for medical services under your name. According to the Medical Identity Fraud Alliance, more than two million Americans have been victims of medical identity theft. Read on to learn how to keep your information safe.

Signs of Medical Identity Theft

The exact warning signs of healthcare identity theft will vary depending on the situation. Keep an eye out for the following:

• You get a bill for medical services you didn’t receive.
• You get calls from debt collectors about unfamiliar medical bills, or see medical collection notices that you don’t owe on your credit report.
• Your health plan informs you that you’ve reached your benefit limit, though you know that can’t be right.
• You’re denied insurance due to a condition on your records that you don’t actually have.

How to Prevent Medical Identity Theft

As with any sort of identity fraud, preventing medical identity fraud begins with protecting your personal information, both in paper form and online. Read our Identity Theft Protection Checklist and our guide to protecting your identity online for best practices. In addition, carefully read your medical and insurance statements with an eye for suspicious activity. This includes both Explanation of Benefits (EOB) statements and Medicare Summary Notices. Verify the name of the provider, date of service, and service provided. If something doesn’t add up, contact your health plan to report the problem. Keep a record of this correspondence.

Recovering from Medical Identity Theft

Medical identity theft cases can take a lot of legwork to unravel. As a first step in any sort of identity theft, report your case to the Federal Trade Commission. From there, begin the process of requesting and correcting your medical records. Follow these steps and document who you contact and when as you go:

• Request copies of your medical records from each doctor, hospital, clinic, and pharmacist where the thief may have used your info. This will require completing medical record request forms and paying associated fees.
• Remember that you have a federal right to know what’s in your medical records.

○     If a provider denies you your records for any reason, such as the privacy of the thief, you can appeal. Contact the person listed in your provider’s Notice of Privacy Practices, patient representative, or ombudsman.

○     If the provider refuses to provide your records within 30 days of your written request, file a complaint with the U.S. Department of Health and Human Services Office.

• In addition, ask for the “accounting of disclosures” for your medical records from each of your health plans and providers. This document lists who got copies of your mistake records from the provider, when, and why. You’ll need to follow up with these parties as well when asking for corrections.
• Review medical records and report any false items to the relevant health care provider.

○     Using certified mail with return receipt requested, write a letter that highlights the errors. Include a copy of the appropriate medical records and the report you filed with the FTC.

○     In your letter explain why the errors are wrong. There are a number of ways you might do this, such as showing that a physical description of the thief does not match you, noting that you were out of town during the time of the appointment, or—in the case of a surgery—proving you don’t have the resulting scar.

• Send a copy of the report you filed with the FTC to your insurer’s fraud department. Include a description of any errors in your records.
• Should you find medical billing errors on your credit report, write to all three credit bureaus to inform them. Save time by using this form letter from the Federal Trade Commision.

Learn more about recovering from identity theft.