Medical ID Theft is Definitely Not What the Doctor Ordered

Vicki Lee Blair, a 63-year-old former computer analyst from Westminster, Calif., had the surprise of her life. Blair went to a clinic seeking antidepressant medication. She said she was shocked when clinicians bombarded her with questions about a blood test in her file indicating thyroid problems and illegal drug use. She insisted the records were inaccurate, potentially the result of an identity theft that occurred a year earlier. And like most victims, her response was, “I never thought this could happen to me.”

Unfortunately, statistics show that it is likely to happen to Vicki, as well as many others.

Medical identity theft affects an estimated 1.5 million people in the U.S. at a cost of $41.3 billion, according to the Ponemon Institute, a research center focused on privacy and data security. The crime has grown as health-care costs have swelled and job cuts have left people without employer-subsidized insurance. Often the information is stolen by employees at medical facilities, and resold on the black market. Thieves also may hack into medical databases or break into medical facilities. And very often, the victim never knows their medical world is being turned upside down until long after the damage has been done.

A child-protection services worker recently accused a woman of giving birth to a child that had tested positive for methamphetamine, although she hadn’t given birth in more than two years. After investigating the phone call, the Salt Lake City mother of four realized she had been the victim of medical identity theft. Turns out a pregnant woman strung out on drugs gave birth using her name and her medical insurance to pay for it. The victim was now in danger of losing her children.

But convincing medical investigators that she hadn’t given birth wasn’t easy. “I said I had not recently had a baby, that my youngest was 2 years old,” the victim explained. “I said, ‘Come meet me and you’ll know that I didn’t just have a baby.’” Investigators still made her life a living hell, she said, questioning her employers and interrogating her children.

Individuals are not the only ones impacted by medical ID theft. The collateral damage can also be felt in the workplace, where the result is often significant increases when it comes renewal time, both in employer premiums and employee contributions. And very often hospitals are in no hurry to help the recovery process as they have, in most cases, already been paid their premiums. To many victims, this feels like a clear-cut case of not being accountable to a problem that may have arisen from a hospital or medical facility having their data either physically stolen or cyber-stolen.

“What makes it so difficult is you have to go provider by provider, hospital by hospital, office by office and correct each record,” said Sam Imandoust, a legal analyst with the Identity Theft Resource Center. “The frustrating part is while you’re going through and trying to clean up the records, the identity thief can continue to go around and get medical services in the victim’s name. Really there’s no way to effectively shut it down.”

Some forms of identity theft can take as little as a few days to resolve, since banks and other financial institutions are generally equipped to handle the complaints. But medical identity thieves typically get treatment at five facilities or more, and the system isn’t set up to fix those kinds of errors. In another case, a man received a $44,000 bill for surgery he never had. “The hospital actually thought that I was going make this $44,000 payment, and here I was proving to them I had no scars from a surgery,” he said. “And they said, ‘No, we’re going to go ahead and pursue this.’ I said, ‘Are you kidding me?’”

Complicating the process of fixing one’s medical records is that some victims face resistance in obtaining files from doctors. The physicians’ reason? The files contain sensitive health information about the imposter.

A few individuals, however, are doing what it takes when it comes to making hospitals accountable. According to CBS/New York, 12 people filed a $50 million lawsuit against a New York City hospital after medical records with their personal information were stolen. They claimed since the fall of 2010, medical records with full names, addresses, Social Security numbers, dates of birth, medical histories, and other information were stolen from the hospital.

“If the public cannot trust North Shore University Hospital and its hospital network to safeguard and secure their private identity, and health, confidential, sensitive information, how can they trust them with their lives?” said plaintiffs’ attorney Bonita E. Zelman.

According to the Bloomberg News website, here are the most common types of medical-ID-theft scams to watch for:

§   Illegal and bogus treatment. Medical ID thieves bill your health plan for fake or inflated treatment claims. Thieves buy patient information and set up fake clinics to make bogus claims.

§   Buy addictive drugs. Medical personnel with access to your data may use your identity to obtain prescription drugs to sell, or feed their own addictions. Dishonest pharmacists might bill your policy for narcotics, or nurses may call in prescriptions in a patient’s name but pick it up themselves.

§   Obtain free treatment. Medical ID thieves who don’t have their own health coverage often receive free medical treatment, courtesy of your policy. They assume your identity at a hospital or clinic, and your policy receives the bills.

The price you pay?

§   Ruined credit. Thieves often ring up large hospital bills in your name. This can ruin your credit.

§   Inaccurate records. A thief’s treatment history can end up on your medical records. This could include the wrong blood type, or medicine to which you’re allergic. Your life thus could be on the line if you receive the wrong treatment based on the thief’s treatment. Your records also could be falsely saddled with damaging — and inaccurate — diagnoses such as mental illness.

§   Legal troubles. A pregnant woman (whom we cited previously) stole the medical identity of a mother, and delivered a baby who tested positive for illegal drugs. Social workers tried to take away the real mother’s four children, falsely thinking she was the addict. She had to hire a lawyer to keep her family.

§   Higher health premiums. False claims against a health-insurance policy can raise your health premiums — costing you yet more money.

There are ways to fight back, or at the very least keep things in check. For instance, make it a point to keep your eye on the explanation of benefits form sent by your health insurer. I know you might get a Popsicle headache trying to decipher all the numbers and medical and insurance jargon, but it is important. Check your medical records frequently as thieves can alter information. Don’t let somebody play games with your life.

If you see inaccuracies on your medical records, make every effort to fix them. But be forewarned, unless you are a trained expert at such things, it can be a very daunting task. Correcting records can be hard. In general, federal law lets patients correct medical records created only by the medical provider or insurer that now maintains your information. A hospital or insurer that later receives your information doesn’t have to correct its records — even when they’re wrong. But you do have the right to have your records state that you disagree with the information, and why. Be sure your complaint is entered into your records.

The seriousness of medical ID theft has not been lost on employers, who have now started offering recovery service to their employees as a value-added benefit, which is important because it can sometimes take hundreds of hours to correct mistakes, hours that are often spent on company time. These benefits can usually be offered by the company’s insurance agents and brokers, who have now viewed offering an ID-theft-recovery package as a way to not only bring value to their clients but as a substitute for lost commissions which have started to fall by the wayside over the past 10 years or so with the economic crunch. Although some companies offer credit monitoring as an employee benefit, credit monitoring does not reveal cases of medical ID theft.

When it comes to medical ID theft it’s not a question of “if” but “when.” So when it happens, the key is to find out the information as quickly as possible and then sign-on with a company that will conduct the recovery as rapidly and painlessly as possible, as traditionally some cases can take years to resolve, longer than other forms of identity theft. It’s not uncommon for victims to still be fighting cases for more than 10 years. But it’s a battle worth fighting in order to fully reclaim your medical identity.

There was a story recently about a thief who stole a person’s dental records and racked up thousands of dollars in dental work. The victim’s advice to his family: “If I ever die and there’s only dental records, make sure it’s me. I might be on vacation somewhere.”

Christopher Durso is CEO/co-founder of ID Theft Solutions USA, based in Mahwah, NJ. Contact him at chris@idtheftsolutionsusa.com or for more information, visit www.idtheftsolutionsusa.com