Medical Identity Theft What It Is And Considerations For The Healthcare Provider
by William E. Hopkins, Thompson & Knight, Austin, TX
Everyone is familiar with the concept of financial identity theft. There are television programs about it, credit card companies run commercials bragging about their theft deterrence systems and zero liability programs, and notices are regularly provided to consumers providing tips on how to prevent it from happening. Medical identity theft, (MIT) on the other hand, is an equally significant problem with equally devastating potential results, yet it receives little or no public recognition or attention. Also unequal are the available remedies to victims. Victims of financial identity theft can depend on rights such as the ability to see and correct errors in their credit report, the ability to file fraud alerts, the right to obtain documents or information relating to transactions involving their personal information, and the right to prevent consumer reporting agencies (such as credit bureaus) from reporting information that has resulted from identity theft. By contrast, victims of MIT do not have a similar complete set of rights or redresses. Victims of MIT do not have the blanket right to correct errors in their medical files. In some cases, victims have not been allowed to even review the compromised files, nor do they have the right to prevent healthcare providers, medical clearinghouses, or insurers from reporting and re-reporting information that has resulted from identity theft. Based on statistics acquired by the World Privacy Forum from the Federal Trade Commission (FTC) for their 2006 report, there have been 19,428 complaints regarding MIT from January 1, 1992 through April 12, 2006, received by the FTC through its Consumer Sentinel database. Given these are only the reported numbers, and these numbers only run through 2006, it can only be imagined what the actual occurrence numbers must be and how many instances go unreported or undiscovered. In general, not only is the public is generally ignorant of this crime and its potential effects, the healthcare industry and the federal and state agencies responsible for protecting citizens against identity theft matters have failed to adequately recognized its enormity as well.
Unlike financial identity theft, MIT is a crime that can go well beyond financial difficulties; it can cause great physical harm as well. Often, MIT leaves a trail of falsified information in medical records that can plague a victim's medical and financial life for years. These fraudulent changes can result in financial losses, loss of reputation based on false diagnosis, patients not getting the treatment and care needed, receiving the wrong type of treatment or care or receiving insurance denials based on inaccurate medical histories. In its worst case scenario, the misinformation created by this type of fraud can cost someone his or her life.
Medical Identity Theft: What is It and How Does it Happen?
In this crime, a victim's medical identity, usually their name, address, social security number and health insurance information is stolen or appropriated through some form of access to the victim's medical file. Most often, this access is acquired through documentation found in the office of a healthcare provider, a medical records storage company, insurance company or other location. Often the information is appropriated by someone who has unique access to it, such as an employee, care provider or other type of records worker. Once acquired, the information is then used, without the victim's knowledge, to make false claims or fraudulently receive medical goods or services. Frequently, in order for the fraud to be effective, the victim's medical information, such as blood type, prescription history, allergies or chronic diseases, is changed as a part of the false care being rendered. These changes, made to the victim's actual medical records, are where the danger begins for the victim. Since changing the billing address and the contact phone numbers on the medical chart is necessary to hide discovery of the crime, the victim often has no idea that a crime has been committed or that changes have been made until long afterward. The usual signs of MIT are: overdue bills for services never received, receipt of explanation of benefits for services not received or when receiving care, recognizing that unauthorized changes have been made to the patient's health record.
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Note the author's article proceeds with a discussion relating to medical identity theft and its implications as it relates to HIPPA. This and more all adds up to areas that require, in my view, the upmost attention by all doctor CEO's.
My thanks to the American Bar Association for permission to share this invaluable material. |
