In 2011, 200 people in Arizona, Florida, Michigan and New Jersey received almost $9.6 million in Medicaid benefits. The problem? They were already dead when they received these benefits. Claiming services in the names of the deceased is just one of several examples of medical fraud, specifically medical identity theft. You may be familiar with run-of-the-mill identity theft, but its lesser-known cousin can be more enduring. Regular identity theft may involve a credit card or bank account number that may be protected by a loss limit, or by insurance through the banking institution or the FDIC.
Unfortunately, the information that is stolen in medical identity theft (e.g., your name or Social Security number) is not something you can change as easily. Unfortunately, the damages associated with medical identity theft also don’t have limits. The thief may use your identity to obtain medical services, buy prescription drugs or submit false claims in the patient’s name. Victims often foot the bill for damages. One recent study found that 65 percent pay an average of $13,500 to resolve the crime, and only 10 percent of victims achieve a completely satisfactory resolution. Medical identity theft usually occurs locally. In other words, the majority of health care data breaches result from a lone computer being stolen rather than hacking into an organization’s mainframe data system.
Among these common thefts, two-thirds happen when a laptop or tablet is stolen, or when an unauthorized person accesses records via email, a computer terminal or network server. Moreover, 22 percent of breaches still involve paper records.
To prevent medical identity theft and other types of health care fraud:
• Don’t give out your Medicare, Medicaid or Social Security numbers to unauthorized people
• Keep records of your doctor visits, tests and procedures in a health care journal or on a calendar
• Review your Medicare Summary Notices and Part D Explanation of Benefits to compare the services that were billed against the dates and procedures performed, as recorded in your journal or calendar
• Carefully review your billing statement to check for charges for something you did not receive, double billing for the same thing (even though a different term may be used), and any services you did not receive and that were not ordered by your doctor
• Whenever you visit a medical provider, don’t be shy about asking questions about his recommendations, whether or not certain tests or procedures are necessary and what they will reveal, and if there are less expensive options
• Always call your provider(s) if you have questions about your bill If you suspect any fraud, you are the front line to save taxpayers billions of dollars each year.
You can report your findings to an agency that will investigate further. Remember, while most health care fraud is committed by a small minority of unscrupulous health care providers, they tend to repeat their scams often, so the more reports received from victims, the better the chances that they will be identified and convicted.
To report your suspicions, collect the following information to help verify your claim:
• The provider’s name and any identifying number you may have • Information regarding the service or item you are questioning
• The date the service or item was supposedly given or delivered • The payment amount approved and paid by Medicare
• The date on your Medicare Summary Notice • Your name and Medicare number (listed on your Medicare card)
• The reason you think Medicare should not have paid the claim to the provider
To report suspected errors, fraud or abuse, you can contact either the Office of Inspector General for the Department of Health & Human Services at 800.447.8477 (TTY: 800.377.4950), the Report Fraud Online at http://oig.hhs.gov/fraud/report-fraud/index.asp, the Centers for Medicare & Medicaid Services at 800.633.4227 (TTY: 877.486.2048) or the Medicare Beneficiary Contact Center at mailing address P.O. Box 39, Lawrence, KS 66044.
1. Government Accounting Office. May 14, 2015. “Medicaid: Additional Actions Needed to Help Improve Provider and Beneficiary Fraud Controls.” http://www.gao.gov/products/GAO-15-313. Accessed July 8, 2015.
2. Ponemon Institute. February 2015. “2014 Fifth Annual Study on Medical Identity Theft.”http://medidfraud.org/2014-fifth-annual-study-on-medical-identity-theft/. Accessed July 8, 2015.
3. HealthDay. April 14, 2015. “Unauthorized Breaches of Medical Records on the Rise.” http://consumer.healthday.com/bone-and-joint-information-4/computer-related-health-news-143/unauthorized-breaches-of-medical-records-on-the-rise-698366.html. Accessed July 8, 2015.
4. Stop Medicare Fraud. 2015. http://www.stopmedicarefraud.gov/reportfraud/index.html. Accessed July 8, 2015