Of all the ways we are victims of identity theft, truly the most devastating could be fraudulent theft of medical benefits. Although it is the least studied and worst documented form of crime, it has far-reaching and almost irreversible repercussions. Recent federal and state legislation have provided consumers with a wide range of rights and protections to combat the effects of financial identity theft. In stark contrast, victims of the misuse of their “medical identity” are often left without resources and face almost insurmountable challenges as they attempt to correct fraudulent medical information.
The real damage in these cases occurs when a victim’s medical history is changed to suit the thief’s needs. Unlike your credit file (s), you do not have the same rights to correct or dispute the medical information in your file. To illustrate the point, let’s turn to the 1996 case against Dr. Richard P. Skodnek of Massachusetts. Dr. Skodnek was convicted of more than 130 fraud charges related to false Medicare and insurance billing. The formerly highly respected psychologist had submitted claims to his patients’ insurance providers for missed appointments and treatments. In some of the cases, he also claimed to treat his patients’ siblings when in fact he had not even met them. All of these fraudulently billed “sessions” and related diagnoses were documented in each victim’s personal and permanent medical history. Wrote a judge in the case reviewing the impact on the victims;
“The evidence suggests that once claims are entered, they cannot be removed from the system. The most that can be done is to enter an entry in the computer records to reflect that a particular claim was false.” AND – “Also, even when a notation is entered to show that the billing record was false, the insurance company cannot declare, and the notation, therefore, will not reflect, if Skodnek’s statements on diagnosis, the prescription drugs and / or the patient’s psychiatric symptoms were false. ”
United States v. Skodnek, 933 F. Supp. 1108 ,; 1996 US Dist. LEXIS 9788 (DD Mass. 1996)
With this statement in mind, remember that your medical information is also used to make decisions about you in addition to treating your illness. Victims have had all available benefits reduced or used entirely, and have also been denied health or life insurance, security clearances, and even employment.
Detecting theft or misuse is almost as difficult as correcting your information. Some of the ways that people have discovered that they have been victimized include;
- receive someone else’s medical bills at your address
- Collection notices from agencies and attorneys for medical services they never received or from providers they never used.
- notifications from insurance companies, law enforcement, or healthcare providers
- inaccurate information in your medical record (i.e. different blood types or allergies and illnesses that the patient does not have)
- denial of benefits or employment
Although they can be time consuming, there are some steps that consumers can and should take to detect medical identity theft.
- Obtain and review a copy of your report from the Office of Medical Information. All consumers are entitled to one free copy each year under the Fair and Accurate Credit Reporting Act (FACTA). The report includes who has provided information to the MIB, requested its file, and also the consumer’s individual insurance application activity. Visit www.mib.com for consumer information and instructions.
- Review any “Explanation of Benefits” submitted by insurers, even if your balance is $ 0. Contact your insurer immediately if something is not correct.
- Review all statements and invoices sent by healthcare providers and insurers carefully. Never assume that mistakes were accidental and will be corrected. Call and dispute inaccurate entries with both the provider and your insurer.
- Request complete medical records and a report of disclosures annually from each medical provider you see and their insurer (s). Include hospitals that you have visited during the year for any reason. Please review them carefully and discuss errors immediately.
Unlike financial identity theft, monitoring services are not available to alert you when your medical information has been accessed or changed. The detection and correction of this crime will be your responsibility for the foreseeable future. However, the best identity theft monitoring and restoration services available to consumers will include valuable help if you are a victim of this type of theft. The best advice for consumers is to educate themselves and carefully monitor their information and statements. Lastly, seriously consider a top-notch identity theft service for your family that specifically addresses this crime.