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The Federal Trade Commission (FTC) describes medical identity theft as the crime committed by stealing another person’s name, Medicare number, Social Security Number (SSN) and using their personal information to submit illicit medical insurance claims, get treatment, surgery, or prescription drugs without consent. This type of identity theft is a major concern for taxpayers, patients, health plans, health care providers, and health insurers.
Besides disrupting medical care, it causes significant financial losses for taxpayers – recent studies show that besides repaying the insurer for health services obtained by the thief, 65% of medical identity theft victims need to hire legal counsel or hire identity service providers. In the end, it costs them around $13,500 just to deal with the effects of their hacked medical or insurance records, resolve the crime, and fix the damages. The FTC sees medical identity fraud as a growing menace after 2019 reports show a 101% jump in reported cases.
To protect confidential patient information from being revealed without their knowledge or permission, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has set strict national rules. Any willful violation could cost institutional perpetrators financial penalties of up to $1.5 million, per year and per negligence category.
After stealing patient names, diagnosis codes, birth dates, billing information, and insurance policy numbers, crooks often pair with doctors and insiders who know how the insurance billing system works. They bill your insurance plans for bogus treatments or make inflated claims.
Medical identity thieves could assume someone else’s identity to purchase, stockpile, and resell illegal drugs or buy restricted prescription medication such as opioid painkiller pills through the victim’s health insurance plan. They could also use them to feed their own drug habits.
Another scam pulled by medical ID thieves happens when they don’t have their personal policies. In this case, con artists steal and exploit someone else’s personal information to obtain free treatment, surgeries, tests, and government health benefits like Medicaid or Medicare.
Forged medical receipts and stolen credentials could also be sold or used by cybercriminals to create fake identities or to obtain expensive medical equipment such as electric wheelchairs through your insurance benefits. They later resell the devices for profit on the black markets.
A 2015 research by the Ponemon Institute discovered that in 50% of the cases, medical identity theft perpetrators are close family members who have easy access to the victim’s health insurance card, with 23% of people admitting they share their health information with family members and friends.
The Medical/Healthcare sector is one of the most targeted by hackers, in 2016 alone being the source of 376 data hacks, which is 34.4% of all information breaches. Data from medical providers and insurance companies is ten times more profitable on the dark web than financial records.
Even if your personal information was exposed, you might not be a victim yet, but it’s very important to prevent fraud by using a service such as IDStrong to monitor your medical record number, medical accounts, insurance number, name, SSN, address, liens, court records, bankruptcies, or assets.
Identity theft monitoring is used to spot fraudulent activity linked to a person’s sensitive data such as SSN, email address, bank statements, or credit card numbers, and notify the owner that their confidential information has been compromised and/or illegally sold online.
Ask your doctor for copies of medical files and analyze them. Every year, request an Explanation of Benefits (EOB) from your health insurer. Check the list of all benefits paid out through your policy to spot any strange activity, for instance, medical treatments that you didn’t receive.
Keep an eye on your credit history and review it frequently. At least once a year, contact the three main credit bureaus or visit their websites (Equifax, Experian, and TransUnion) to pull a free credit report. If you see anything suspicious, ask them for a credit freeze and a fraud alert.
Don't share SSN, medical, and health insurance information with strangers or companies who claim to offer free products or services via email or on the phone. Keep any other Personally Identifiable Information (PII), mail, or official documents safe even from friends and family.
If you subscribe to a healthcare provider's online patient portal to access your record, always create a strong, unique password that won’t include your SSN or other personal info. Update firewall, spyware, and anti-virus software programs and password-protect any PII files.
A stolen medical identity could have serious consequences such as:
More than 50% of Americans have had their identity stolen at some point or know someone who has been a victim of identity theft, with statistics on medical identity fraud showing the following:
Identity theft occurs when someone uses another person's PII, such as their name, date of birth, driver's license number, social security number, credit card number, bank account, or passwords, without their authorization, to commit crimes. Medical identity theft, on the other hand, is a form of identity fraud that occurs when perpetrators use a patient’s name, Social Security number, health insurance number, and other PII data to purchase medical products, pharmaceuticals, or receive medical services or procedures. The culprits, in this case, are usually “insiders” who work at healthcare facilities and can easily access patient information. They use the info themselves or they sell it to organized medical identity theft gangs.
If you suspect you've been a victim of medical identity theft, here’s what you should do next:
Each health insurance plan is strictly associated with a person and their social security number and it’s illegal to use another person’s insurance plan. However, if you lose your insurance card or if hackers or identity thieves intercept your personal data, they could take advantage of your medical plan to get treatment, drugs, and file health claims with your insurer, in your name, without your knowledge. In this case, the perpetrator’s medical data will compromise your medical records, treatments, insurance, and payment records.
Medical information is at least ten times more valuable than any other identifying data because:
Medical identity thieves usually fall under five categories:
Besides offering identity and credit monitoring, IDStrong helps patients and taxpayers keep their medical identity under surveillance against data thieves. By monitoring a person’s medical insurance number and the medical records number assigned to individuals by hospitals and medical groups, we may be able to help people act against suspicious activities or changes linked to their personal details. Our search engine scours the Internet, including the dark net, underground discussion forums, and black markets. When our search tools identify compromised data, a system of automatic notifications alert the affected user. Therefore, we’re enabling potential victims to take action sooner rather than later which could minimize possible losses and could even help them prevent medical id theft from happening.
Finding someone’s data exposed online doesn’t necessarily mean it’s already been used or bought by criminals, therefore intercepting it on time could make a significant difference in preventing stolen medical identities from being an accessory to a crime.
Health insurance fraud can take place at any point during the medical insurance process, starting with purchasing coverage and ending with receiving care. Therefore, apart from medical identity theft, we have the following types of fraud:
Having a proactive approach towards preventing identity theft makes a huge difference. Patients could stay safe from becoming victims of medical identity theft by adopting some simple cautionary steps such as: