Medical Identity Theft

A dangerous emerging trend, often referred to as “Medical Identity Theft”, thieves and scam artists have discovered the ease in which they may use a victim’s information to obtain healthcare and other medical benefits and services. It is a serious problem and may soon be officially recognized through legislation as a separate and distinct form of the crime. In a report by Elizabeth Roop of Radiology Today, the World Privacy Forum has estimated that fraudulent medical billing resulting from medical identity theft can range from $1,000 to as high as $1 million per incident. Pam Dixon, Executive Director of the World Privacy Forum, said “We get a lot of complaints that are in the $20,000 to $150,000 range; that’s very common. If someone called up and said, ‘I had debt collectors knocking on my door wanting $90,000,’ we wouldn’t even blink.”

In addition to the obvious problems caused by fraudulent billing that may result from the healthcare services obtained in the victim’s name, there is an even more distressing, and potentially life-threatening danger—incorrect medical files. The thief’s misuse of the victim’s information to obtain healthcare services could result in the victim’s medical files and related information entered into medical databases becoming infected with incorrect or mismatched information (the thief’s rather than the victim’s) such as an inaccurate medical history, missed or incorrect documentation of allergies to certain medications, inaccurately documented health conditions or diagnosis, and other dangerous mistake that could put the victim’s health in jeopardy. Victims may also suddenly and unexpectedly discover that their insurance benefits coverage has been exhausted, that they no longer qualify for medical or life insurance due to erroneously reported “pre-existing” conditions, or receive a notice of cancellation or substantial increase in their insurance premiums due to inaccurately documented medical conditions.

Errors in medical files can be very difficult to detect and correct, as victims of medical identity theft are not extended the same rights and protections as victims of financial identity theft. If your record is corrupted by inaccurate information, there is often no way to correct it. For instance, information in a hospital database may be forwarded to a doctor for review and subsequently added into his/her database. Information in the doctor’s database may then be forwarded to an insurance company for billing purposes, and entered into that company’s database. Information from the insurance company database may then be forwarded to the Medical Information Bureau database, used by many health care providers and insurance companies. At this point, all of these databases have become contaminated with the incorrect health information, and correcting them all is virtually impossible.