How to Protect Yourself From Medical Identity Theft

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

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Assessing Risks Reduces Severity, Frequency of Falls - AGT The Safe Money People

Following the adage “Knowledge is power” can literally keep us from falling down. In the U.S., one out of every three people over 65 takes a tumble each year, and 20 to 30 percent of those who survive incur moderate to severe injuries. Yet, those who have taken the time to assess the risk of falling in their homes are less likely to be in that one-third.1 It may not be surprising that, once someone has taken a spill, they inherently develop a fear that makes them more cautious about preventing another fall. For the majority of the population, that’s a good instinct. But for seniors, it can make them withdraw from certain activities. Ironically, this new caution can increase their risk of falling again, particularly by preventing them from taking routine walks or another form of exercise. To help address this phenomenon, the U.S. Department of Health and Human Services sponsored a study to measure whether a personalized program of intervention could help reduce the risk of an older person taking a fall. The program includes an in-home physical, emotional and cognitive functioning evaluation, a detailed record of a person’s history of falls, an assessment of the home environment and an inventory of current medications that may impact the person’s sense of balance. All of these factors are taken into consideration and used to create a customized recommendation for the individual. Some risk factors are intrinsic, meaning they are linked to the person’s health and habits. Other risks are extrinsic, which refers to those associated with the home environment.” As part of the study program, participating seniors are educated on both types of risks and how they may be avoided. For example, someone who routinely gets up to go to the bathroom in the middle of the night may have been doing it for so long they do not need to turn on a light. However, as they age, their senses may not be as sharp and they may not notice a new obstacle in the path. Installing a nightlight to guide their path to the bathroom could be a simple solution that greatly decreases their fall risk. Participants in the study who received intervention training and recommendations experienced a 13 percent lower rate of falls than ones who did not, and those who did experience falls were less likely to suffer a serious injury. Moreover, their long-term insurance claims were 33 percent lower over a three-year period, suggesting that this awareness may have had a long-term impact on both cognitive and physical health. This isn’t terribly surprising, seeing as the study also found participants were nearly 20 percent more likely to make fall-preventing modifications to their home than nonparticipants. 1. ThinkAdvisor.com. Aug. 3, 2015. “Elders’ Risk of Falling Is Falling.” http://www.thinkadvisor.com/2015/08/03/elders-risk-of-falling-is-falling. Accessed Aug. 5, 2015.

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