Of all the ways we become victims of identity theft, the fraudulent theft of medical supplies is the most devastating. Although it is the least studied and most documented form of crime, it has far-reaching and almost irreversible consequences. Recent federal and state legislation has provided consumers with an extensive range of rights and protections to combat the consequences of financial identity theft. In stark contrast, those who have been victims of abuse of their “medical identity” often find themselves without recourse and face almost insurmountable challenges as they attempt to correct fraudulent medical information.
The real damage in these cases occurs when a victim’s medical record is modified to suit the thief’s needs. Unlike your credit record(s), you do not have the same rights to correct or contest the medical information on your record. To illustrate this point, we refer to the 1996 case against Dr. Richard P. Skodnek of Massachusetts. Dr. Skodnek was convicted of more than 130 counts of fraud involving fake Medicare and insurance bills. The formerly highly respected psychologist had filed claims against his patients’ insurance companies for treatments and appointments that were cancelled. In some cases, he also claimed to treat his patients’ siblings when in fact he had never met them. All of these fraudulently billed “sessions” and related diagnoses were documented in each victim’s personal, permanent medical history. A judge on the case assessing the impact on victims wrote;
“The evidence suggests that once the claims are entered, they cannot be removed from the system. The best that can be done is to enter an annotation into the computer records to indicate that a particular claim was false.” And – “In addition, even if an endorsement is entered to show that the billing statement was false, the insurance company cannot state – and thus the endorsement will not reflect – whether Skodnek’s statements about the patient’s diagnosis, prescription drugs and/or psychiatric symptoms were false.”
United States v. Skodnek, 933 F. Supp. 1108,; 1996 US Dist. LEXIS 9788 (DD Mass. 1996)
With this statement in mind, please remember that your medical information is also used to make decisions about you other than the treatment of illness. Victims have reduced or used up available benefit totals and have also been denied life or health insurance, security clearances and even employment.
Detecting theft or misuse is almost as difficult as correcting your data. Some ways people discovered they had been victimized include;
- receive someone else’s medical bills at their address
- collection notices from agencies and attorneys for medical services that they never received or from providers that they never used
- reports from insurance companies, law enforcement or health care providers
- incorrect information in their medical record (i.e. different blood group or allergies and diseases that the patient does not suffer from)
- refusal of benefits or work
While they may be time consuming, there are some steps consumers can and should take to detect medical identity theft.
- Obtain and view a copy of your report from the Medical Information Bureau. All consumers are entitled to one free copy per year under the Fair and Accurate Credit Reporting Act (FACTA). The report includes who reported information to the MIB, requested your file and also the activity of the consumer’s individual insurance application. Visit www.mib.com for consumer information and instructions.
- Review every “Explain of Benefits” sent by insurers – even if your balance is $0. Contact your insurer immediately if something is not right.
- Carefully review all overviews and bills from healthcare providers and insurers. Never assume that errors were accidental and will be corrected. Call and question inaccurate entries with both the provider and your insurer.
- Obtain complete medical records and disclosure records annually from every medical provider you visit and from your insurer(s). List hospitals you visited for any reason during the year. Review them carefully and immediately dispute any errors.
Unlike financial identity theft, surveillance services are not available to alert you when your medical information has been accessed or altered. The detection and correction of this crime will be your responsibility in the near future. However, the best identity theft monitoring and recovery services available to consumers provide valuable assistance if you fall victim to this type of theft. The best advice to consumers is to inform yourself well and to carefully check your information and statements. Finally, seriously consider a top-notch identity theft service for your family that specifically tackles this crime.