Medical Identity Theft and Its Serious Offshoots

Medical Identity Theft and Its Serious Offshoots

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Insurance Fraud – Risks Involved The medical chart review performed for an insurance company has to be precise and comprehensive to prove aspects such as fraud, medical necessity, and medical malpractice and ensure a fair settlement in personal injury and other medical litigation. Insurance fraud is a major concern now for insurers, with people knowingly indulging in fraudulent activities to obtain a benefit to which they are not entitled. Fraud resulting from medical identity theft has become a vicious crime at present with a number of healthcare insurers falling prey to it.

Fraudsters steal the personal information of others and obtain medical services or make money with falsified claims against a genuinely insured person’s health policy. These medical thieves steal health insurance numbers, social security numbers and other personal information and sell them on the black market. They hack into medical databases creating havoc. The sad part is that often this type of crime comes to light only after the damage has been done. 

A dangerous consequence of medical identity theft is that the thief’s health history will become mixed up with the original insured person’s. This will lead to problems with health insurance, medical treatment, payment records and credit report.

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Access to an insured person’s name, address and date of birth is sufficient to commit the crime. Since hospitals have to treat emergency patients quickly, incorrect medical and insurance information will reach the billing department before the identity theft is detected.

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The victim whose medical identity is stolen may be in danger when he/she goes for some medical treatment because the medical records may have been changed to include the perpetrator’s medical history and health conditions.

This year major health insurers including Premera, Anthem, and Carefirst became victims of serious data breaches and it is estimated that around 92 million medical records have been

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affected. According to the Identity Theft Resource Center, the medical/healthcare sector has made up the highest percent, i.e. 42.5% of total hackings of any industry.

How Cybercriminals Profit from Fraud How do cybercriminals profit from the data they steal? As mentioned earlier, they may get health services for themselves or sell the information to uninsured persons who need care.

More than these, medical identity thieves profit the most through Medicare/Medicaid and health insurance fraud. Forbes.com gives a good example of this kind of fraud. The fraudster could assume a fake identity as a medical equipment seller and sell electric wheelchairs. They can bill the government thousands of dollars for electric wheelchairs they never dispatch, for the Medicare/Medicaid numbers they receive. This same kind of fraud can be committed using prescription drugs.

This vicious crime is fueled by the increase in the use of electronic medical records and rising data breaches that occur at health insurance/medical provider offices. To make matters worse, a victim may not be able to examine his/her own medical records completely since the thief’s medical data that is now integrated with their own, are protected by medical privacy laws!

Meanwhile, hospitals may continue to bill victims for services they didn’t receive. A survey published by the Ponemon Institute LLC in February this year shows that medical identity theft affected 2.3 million adult patients in 2014 versus 1.4 million in 2009.

Measures to Prevent Medical Identity Theft With the alarming incidence in the number of such cases, federal agencies such as the Department of Health and Human Services, Federal Bureau of Investigation and the Justice Department are intensifying joint investigations. Blue Cross Blue Shield Association and Aetna Inc. along with other companies have joined to form the Medical Identity Fraud Alliance. An www.mosmedicalrecordreview.com

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improvement measure adopted by hospitals to prevent medical identity theft is biometric screening to confirm patient identities. A South Georgia hospital will soon allow their patients to have their personal medical information at their fingertips, according to recent news in walb.com. Tift Regional Health System will be installing a new finger-scan identification system in its registration areas soon in partnership with a healthcare intelligence solutions company.

The biometric technology uses points on the fingertip to create a distinctive code that associates patients with their health information so that nobody else can use it.

Attorneys utilizing medical review service should ensure that the healthcare information they share with their partnering companies is safe from data breaches.

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