Cyber security

Medical Identity Theft: Top Tips for Healthcare Firms



The theft of a person’s health insurance information is known as medical identity theft. To receive reimbursement for medical services rendered to someone who isn’t covered by the policy. Depending on the circumstances, both patients and providers may make false medical claims. Prescription drugs, doctor appointments, and medical equipment are examples of these services. To receive payouts, criminals may submit false claims to health insurance companies.

Even though most people associate identity theft with financial loss and transactions, it can also occur in medical attention. According to Medical Research, Medical identity theft occurs when someone uses someone else’s medical information. For example, fraudsters obtain medical treatment, prescription drugs, or surgery using another person’s name or insurance information. It can also happen when a medical person is untrustworthy in using the tip of another person. As a result, they submit false insurance claims. Patients, health care providers, and health plans all worry about medical identity theft. As a result, healthcare providers and insurers think about reducing the risk and assisting victims

What’s in it for the defaulters?

It’s easy to overlook the seriousness of these scams at first, believing there is nothing to be concerned about the things. However, combining a thief’s and your health information can ruin your credit, reputation, and, even worse, your life. For example, assume a data breach occurs, and a fraudster gains access to sensitive information such as your Protected Health care Information (PHI). Your PHI is worth anywhere from $250 to $1000 on the Dark Web. That’s 1000 times the value of a stolen SSN (Social security number).

What Sets Medical Identity Theft Apart from Other Forms of Identity Theft?

  • In 2021, the average cost of a data breach in the United States healthcare industry was 9.23 million dollars.
  • On the black market, stolen health information is 20 to 50 times more valuable than other types of identity fraud.
  • Let’s pretend someone gets their hands on your health insurance information. They can pose as you for years and collect health benefits on your behalf without your knowledge.
  • Unless you’re in an emergency or receive unexpected reports from your health insurance provider, you’re unlikely to find out. It might be too late by then. The thief may have used up all your health benefits or gathered thousands of dollars.

How can people tell if they’ve been the victims of medical identity theft?

Victims may:

  • Victims may get charged for a bill of medical services if they did not receive contact from a debt collector about the medical debt they do not come across medical collection notices on their credit report that they are unfamiliar with.
  • On their explanation of benefits, look for incorrect listings of office visits or treatments (EOB) explanation of benefits.
  • Be told by their health plan that they have reached their benefit limit or Insurance was denied because their medical records showed they had a condition they didn’t have.

What could healthcare firms do if their patient’s medical identity has been stolen?

Investigate the situation: 

For instance, if a patient claims to have been billed for services she didn’t receive, check your records for the services performed and any supporting documentation verifying the person’s identity. You should also check the patient’s medical record for any discrepancies.

If you suspect medical identity theft, notify anyone who had access to the patient’s medical or billing information. Inform them of any inaccuracies in the patient’s records and request that they be corrected.

Recognize your responsibilities under the Fair Credit Reporting Act (FCRA):

Determine how identity theft affects your FCRA responsibilities if you report debts to credit reporting companies. For example, the FCRA says you can’t write any debt associated with the robbery to credit reporting companies if the patient gives you an identity theft report. This is because the information from credit reporting agencies and businesses confirms that the consumer is a victim. The report also reveals who stole accounts and which data was incorrect.

Unexpected physical mail:

What’s in your mailbox could be a warning sign of identity theft.

  • Unknown mail is the first and most obvious sign. If you receive credit card statements or letters from undisclosed agencies, it could indicate loan fraud. Someone is applying for loans or credit cards in your name, potentially racking up fraudulent charges on which you could be held liable.
  • Unemployment scams are a new trending fraud. If you receive a letter from unemployment with information about benefits you never claimed, you are most likely a victim of identity theft.
  • Medical identity theft is another possibility. In this case, you may receive written notices from a health insurance company about unrelated claims.

How can Healthcare firms assist their patients in preventing, detecting, and defending themselves against medical identity theft?

Medical Identity Theft is a booklet available from the Federal Trade Commission.

It explains how medical identity theft works and how it differs from traditional identity theft and how to stay away from becoming a victim and recover if you are. The brochure comes in two languages: English and Spanish. The Federal Trade Commission encourages you to print copies and distribute them to your patients. You can also link to, reproduce, or adapt the brochure for your website or newsletter. Furthermore, the HIPAA Privacy and Security Rules contain several requirements that, if adhered to, will significantly reduce the risk of medical identity theft. The Privacy Rule, for example, requires HIPAA-covered entities to confirm the identity of individuals requesting protected health information.

How can you guard against medical identity theft?

 Medical identity theft prevention tips will help protect your records and aid in the recovery process if the unthinkable happens. When someone uses another person’s medical information, they commit medical identity theft. To imitate someone else, thieves may steal a social security number, a health system ID, a driver’s license, a health insurance policy number, and other personal information.

Other precautions you can take regularly include:

  • If you’re a credit card account number, you can’t avoid phone solicitations. Always avoid offers of free services and services the provider will waive your copayment (BCBSA). Also, never sign a blank insurance form.
  • Don’t let your insurer’s explanation-of-benefits statements pile up in your inbox. Instead, examine them as if they were a restaurant bill or a grocery receipt. Call to inquire about an unfamiliar procedure, doctor name, or service date.
  • Keep an eye out at the doctor’s office. Are other patients’ records accessible?

Is It Possible to Avoid Medical Identity Theft?

Yes, you can destroy any old documents that contain personal information. Keep your eyes on your credit because unpaid bills may end up in collections under your name, damaging your credit. Review your medical records at least once a year. Keep copies of your medical records as evidence of accuracy.


How does medical identity theft happen?

It occurs when someone steals your identity and uses it to obtain medical care, prescriptions, or payment for healthcare services in your name. Medical ID fraud can hurt your medical records, health insurance costs, and, in the long run, your credit report.

Is medical identity theft the same as HIPAA?

Protected health information (PHI) is the foundation of HIPAA privacy, but it is widely misunderstood, inadvertently causing organizations to violate the law. For example, most people believe that PHI includes diagnoses or medical information.

Is medical identity theft the fastest growing form of identity theft?

Over 1.8 million people around the world were victims of medical identity theft in 2013, according to the Identity Theft Resource Center in San Diego. Furthermore, they were growing at a 32 percent annual rate, making it the fastest-growing type of identity theft.

What is the most efficient method of avoiding medical identity theft?

The three most effective ways to avoid medical identity theft are as follows. Keep your medical records safe. Keep your health information to yourself. Should recognize early signs of medical theft. Be wary of emails requesting your medical information. Keep an eye on your credit score and review your credit report regulary.

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