How to Avoid Medical Identity Theft

Between 250,000 and 500,000 Americans have already become victims of the growing crime of medical identity theft.  Medical identity theft happens when someone uses your name and other pieces of your history, such as insurance information, without your knowledge to obtain medical services and goods.

The ramifications of this crime are widespread. You could be billed for medical services that you never received. You might make a legitimate insurance claim, only to be told by your health plan that you have reached your benefits limit. The wrong blood type or other misinformation could be noted in your medical records. Your history might indicate illnesses that you never had, as a result of which you could be denied health insurance. An entire fake medical record could be created with your name and other personal information in it.  Errors such as these can remain undetected and uncorrected for years.

Medical identity theft is not a small problem. According to the Federal Trade Commission, victims of medical identity theft comprise about 3 percent of the 8.3 million overall victims of identity theft.  Nine million adult Americans (4 percent) believe they or a family member have been a victim of medical identity theft.

If you think that your health information is protected under HIPAA, the Health Insurance Portability and Accountability Act, think again.  Technically, HIPAA, often referred to as the “health privacy rule,” gives you the right to access your health records.  If you are a victim of identity theft, however, you could be denied access because your records now contain the private, “protected” health information of someone else, even though that someone else is a criminal.

Fortunately, there are several steps that you can take to safeguard your medical identity.
Never give your medical information to anyone unless you know with whom you are dealing and you initiated the conversation. Bear in mind that a caller posing as a representative from your insurance company, a federal agency, or your doctor’s office can glean a wealth of data. When it comes to your health and medical information, it’s smart to be suspicious of any and all callers requesting information.

Guard your medical information with care. Shred all your documents containing medical information before you discard them. If you keep copies of your medical or health insurance records, make sure that they’re secure, whether they’re on paper or in an online file.  When you use the Internet to access information related to your medical care or insurance, check each site’s security policies. Destroy labels on pill bottles and packages before you throw them out.

When you receive your monthly Explanation of Benefits from your health insurance company, check it carefully. Be absolutely sure that you and only you received the treatments and  prescriptions detailed there.

Because medical identity theft often shows up first when a claim is sent to a billing department, obtain an annual credit report.  An unpaid medical bill on your credit report could be a major clue that you’re a victim of medical identity theft.

Make the effort to get a copy of all your medical records. Because there is no central repository, you will need to contact every provider, including doctors, clinics, hospitals, pharmacies, laboratories, and health plans. You will probably have to complete a form and pay a fee to get a copy of your records, and it may take some time to get all the information.

If you believe that you are a victim of medical identity theft, take the following three steps.

1. File a complaint with the Federal Trade Commission online at or by phone at 1-877-ID-THEFT (438-4338); TTY: 1-866-653-4261.

2. File a report with your local police and send copies of the report to your health plan’s fraud department and all your healthcare providers.

3. Write to your health plan or provider, detailing the information that seems inaccurate. Include copies (keep the originals) of any document that supports your position. In addition to providing your complete name and address, your letter should identify each item in your record that you dispute, state the facts and your reasons for disputing the information, and request that each error be corrected or deleted. You may want to enclose a copy of your medical record with the items in question circled. Send your letter by certified mail, and ask for a “return receipt” to document what the plan or provider received. Keep copies of your dispute letter and enclosures.

These days, it’s very important to keep track of your medical identity. If it turns out to have been stolen, take all necessary steps to get your information corrected. It’s an effort, but it could be life-saving.


World Privacy Forum, 2006

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