Doctor, It Hurts When Total Strangers Do This! (Medical Identity Theft, part 2)

Posted on: June 3rd, 2008 by Julie Bestry | No Comments

Patient: Doctor, it hurts when I do this.

Doctor: Then stop doing it.

Note to Paper Doll readers: Due to character limitations on posts, this is actually Part 2 of an extended post. To read the introduction about why medical identity theft is so dangerous, and to link to videos and anecdotes so you take this as seriously as Paper Doll does, be sure to CLICK HERE.

Now, to be sure you’re not one of the 250,000 annual victims of medical identity theft:

1) Protect Your Security…Your SOCIAL SECURITY

Grab your wallet and pull out your health insurance card or Medicare/Medicaid card. If your insurance company or state government-provided insurance, or Medicare or Medicaid, is still using your Social Security number as your insurance identification number, your medical identity is as easy to purloin as your wallet can be plucked out of your purse or pocket.

Just as you shouldn’t carry your Social Security card, if you can’t persuade your insurance company to change your identification number (which more and more companies are doing, at the behest of state governments), DO NOT CARRY your card with you unless absolutely necessary.

Instead, photocopy the front and back of your card, but use a Sharpie to blacken the last four digits. In a non-emergency situation, you can give the last four digits to the medical offices yourself; in cases of emergency, you can be prepared by writing the name and number for your emergency contact on the photocopy, and your emergency contact can provide those last four digits to a medical provider.

2) Request copies of your medical records, insurance claims and credit reports.

First, find out what medical payments your insurance company has made for your (or your dependents’) medical care. Log into your health insurance company account and retrieve past medical billing records and EOBs (explanation of benefits). If your company does not allow digital access, you may have to call or write a certified letter to request copies of your documentation. Even if you haven’t seen a doctor recently, note this task on your calendar once per year so that you can be certain your insurance company is not providing benefits to an “alternate you” at an alternate address.

Next, contact any of your actual doctors and health care professionals for records you haven’t saved during the year, as well as any previously unknown doctors who claim to have treated you, and request copies of your medical records, as allowed under the Health Insurance Portability and Accountability Act (HIPAA). By law, they are allowed to charge you a nominal fee for the cost of photocopies and their staff’s time, but most physicians are willing to waive this if they are given ample time to collect the data. Hard copies of X-rays can be more pricey, and unwieldy, so you may request them to be sent digitally. (Click here for state protections, in addition to HIPAA.)

[It’s unlikely that a physician’s office would refuse to help you unless he or she (or the office staff) were complicit in some kind of fraud. If your doctor refuses you access to your own medical records, file a complaint with the Office of Civil Rights at the U.S. Department of Health and Human Services at 1-800-368-1019 or follow their online instructions.]

If you read and followed the advice in the prior posts in this series, you’ve already accessed free copies of your credit reports from the main credit reporting agencies. When reviewing your financial records, make sure there are no liens or reports of medical debts in for services or locations unrelated to you.

Perhaps most importantly, contact the MIB. (No, not the Men In Black, though alien security services might be less scary than knowing some central organization knows more about you than your mother or spouse!) Just as the major credit bureaus keep copies of your financial records, health insurance companies maintain and share your medical history – at a central repository called the MIB (Medical Information Bureau). The MIB exists to help insurance companies detect and eliminate fraud on insurance applications; for example, if there’s a discrepancy between your report of no history of cancer or high blood pressure and a previous notation about such things in your record, the MIB should catch it.

Your MIB report might include information regarding blood pressure, diabetes, obesity or ongoing reproductive issues, but also data on activities your insurance companies have found out about, anything from smoking to bungee jumping. In some cases, your MIB report can contain data regarding drug-related criminal activity and a bad driving record, depending on the depth of reportage. (So yes, the MIB is scary, but also useful, a lot like the Men in Black.)

Just as your credit report from one of the credit bureaus can make or break your chance of getting a good interest rate on a credit card, mortgage or car loan, your MIB feel can influence the cost of any health insurance premium, or even block whether you can obtain insurance at all! Since the Fair Credit Reporting Act guarantees you the right to a free copy of your report, call 866-692-6901 to order your report (and, if necessary, to dispute any errors found therein.)

3) Review your records as if your life depended on it—because it does!

Create small blocks of time in your schedule to tackle this project so that you don’t become overwhelmed. Sit down with your medical records, insurance claims and notes on lab reports to make sure the dates, locations and maladies track properly, and be on the lookout for unusual entries. If you haven’t left the State of California in two years and haven’t seen any physicians but your regular doctor, but there’s an emergency room notation from nine months ago in Brooklyn, that’s an obvious red flag. Also check for variations on the spelling of your name, as those can provide hints to fraudulent claims (or, of course, sloppy physician handwriting).

Generally, search the documentation for services (visits, lab tests, consultations, etc.) never rendered to you (or your dependents). Watch for mistaken or otherwise inaccurate diagnoses, as well as contact information or address changes that don’t reflect anywhere you (or your dependents) have ever resided (or stayed, if there’s a chance you used medical assistance while traveling) or home/work/cellular numbers you’ve ever used.

In addition to medical information, take note of financial information, such as notes regarding payment of co-pays and odd records regarding items in dispute or delayed collections.

Finally, be sure to note what disclosures of “your” medical history have been made to other government or social service agencies or health providers. Your MIB report can help with this, as it includes a list of companies that have reported information about your medical identity to the MIB during the 12 months prior to your request. (One note: records are purged after seven years. If you haven’t applied/reapplied for insurance in the past seven years, you may not have an MIB report.)

4) Dispute any misinformation.

This may mean making phone calls, personal visits or even certified letters, but armed with your own documentation, dispute any and all incorrect data with your health provider(s), your insurance carrier, and, if necessary, the credit bureaus. Request, or if necessary, demand investigation of the questionable material and, once investigated, removal from your records. Under HIPAA, a medical provider or insurance company that corrects an error is legally obligated to contact each party to whom it has previously released your information (including pharmacies, labs, insurance companies, etc.) to attempt to correct and revise their error.

Copies of all disputes should be in writing. If you have a telephone conversation, transcribe it (by taking notes during the call), and send follow-up copies to the person with whom you’ve been chatting to reiterate what each of you has said, done and/or agreed to do.

5) Call a Cop! Call the Feds!

Seriously. If you find that you are a victim of medical identity theft, file a police report. Do this even if the fraud didn’t actually cost you money, even if you don’t currently have insurance, even if “hate making a fuss”. Someone who has stolen your medical identity would have no compunction regarding stealing your financial identity or legal identity. Beyond this, someone willing to purloin your identity might also be guilty of drug-seeking and related crimes, so completing a police report might be a prophylactic against the police mistaking the bad guy impersonating you for the real you.

You can also call the Federal Trade Commission to file a medical identity theft complaint. The FTC has a toll-free Identity Theft Hotline at 1-877-IDTHEFT (438-4338) and you can file a complaint online, as well.

Also, if you have been the victim of Medicare/Medicaid fraud, call 1-800-HHS-TIPS (1-800-447-8477) or report the fraud online.

6) Get Organized!

The best way to tell whether other people’s records are flawed is to compare them with your own carefully-kept records. Your family filing system should include a section for medical, dental and vision care records, including the physicians you’ve seen, dates of treatment or tests, test results, diagnoses and general treatment plans.

Preserve your financial identity to safeguard your lifestyle; preserve your medical identity to save your life.

Finally, as my dear Paper Mommy would say, zay gezunt!

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