Of all the ways we are victimized through identity theft, truly the most devastating could be the fraudulent theft of medical benefits. Although the least studied and worst documented form of the crime, this one has far reaching and almost irreversible repercussions. Recent federal and state legislation have provided consumers an extensive array of rights and protections to battle the effects of financial identity theft. In stark contrast, those victimized through the misuse of their “medical identity” are often left with no recourse and face almost insurmountable challenges during their attempt to correct fraudulent medical information.
The real damage in these cases occurs when a victim’s medical record is changed to suit the needs of the thief. 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 refer to the 1996 case against Dr. Richard P. Skodnek of Massachusetts. Dr. Skodnek was convicted of over 130 counts of fraud related to false Medicare and insurance billing. The previously highly respected psychologist had been submitting claims to his patients’ insurance providers for treatments and appointments that did not take place. In some of the cases he also claimed to provide treatment to the siblings of his patients when in fact he had never even met them. All of these fraudulently billed “sessions” and related diagnoses were documented in each victim’s personal, permanent medical history. A judge in the case reviewing the impact on victims wrote;
“The evidence suggests that once the claims were entered they cannot be deleted from the system. The most that can be done is to enter a notation in the computer records to reflect that a particular claim was false”. And – “Moreover, even where a notation is entered to show that the billing record was false, the insurance carrier cannot declare–and the notation will thus not reflect –whether Skodnek’s statements about diagnosis, medications prescribed and/or psychiatric symptoms of the patient were false.”
United States v. Skodnek, 933 F. Supp. 1108,; 1996 U.S. Dist. LEXIS 9788 (D. D. Mass. 1996)
With this statement in mind, remember that your medical information is also used to make other decisions about you besides treatment of illness. Victims have had available benefit totals decreased or used entirely and have also been denied life or medical insurance, security clearances and even employment.
Detecting the theft or misuse is almost as difficult as correcting your information. Some of the ways people have discovered they had been victimized include;
- receiving someone else’s medical bills at their 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 their medical file (i.e.; different blood type or allergies and illnesses not suffered by the patient)
- denial of benefits or employment
Although they are potentially time consuming, there are some steps consumers can and should take to detect medical identity theft.
- Obtain and review a copy of your Medical Information Bureau report. All consumers are entitled to one free copy each year under the Fair and Accurate Credit Reporting Act (FACTA). Included in the report is who has reported information to the MIB, requested your file and also the consumer’s individual insurance application activity. Visit www.mib.com for information and instructions for consumers.
- Review any “Explanation of Benefits” sent by insurers – even if your balance is $0. Contact your insurer immediately if anything is inaccurate.
- Review all statements and bills sent by health providers and insurers carefully. Never assume mistakes were accidental and will be corrected. Call and question inaccurate entries with both the provider and your insurer.
- Annually request complete medical files and an accounting of disclosures from each medical provider you see and your insurer(s). Include hospitals you may have visited over the year for any reason. Review them carefully and immediately dispute errors.
Unlike financial identity theft, monitoring services are not available to alert you when your medical information has been accessed or altered. 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 assistance if you are victimized by this type of theft. The best advice to consumers is to educate yourself and monitor your information and statements carefully. Lastly, seriously consider a top-rated identity theft service for your family that specifically addresses this crime.