What is medical identity theft?Feb. 4, 2015, was a watershed moment for the medical industry. On that day, Anthem – one of the nation’s largest health insurers – disclosed that its servers experienced a massive data breach, impacting over 79 million current and former customers. While data breaches are commonplace, this breach brought medical identity theft to the forefront of American consciousness. Today, consumers and medical institutions alike are still dealing with the consequences of this breach and others like it – hospitals have increasingly become the targets of phishing scams and ransomware, and with scammers targeting the healthcare industry, consumers have been more and more likely to fall victim to medical identity theft. Like all types of identity theft, medical identity theft can be financially devastating, but it has the added threat of jeopardizing a victim’s health. What exactly is it, though, and how can you protect yourself from it? Continue reading as we provide an in-depth look into medical identity theft.

What counts as medical identity theft?

Given that medical identity theft is a form of identity theft, it unsurprisingly involves the theft of personal information. Personal information such as social security numbers, full names, credit card numbers and addresses can all be siphoned from hospitals, medical offices and insurance companies, in addition to protected health information (PHI). This data is then used to abuse a victim’s medical coverage and benefits, or access medical coverage or benefits in their name to pay for an identity thief’s healthcare. Though this kind of abuse is the defining feature of medical identity theft, the stolen information can, of course, be used in other fraudulent schemes. This means that medical identity theft often presents victims with a double-whammy of financial ruin and health complications stemming from mixed-up medical charts, denied benefits and more.

How does it happen?

Medical identity theft happens in the much the same way other types of identity theft occur. Thieves can gain the necessary information by hacking databases, finding medical information online or stealing it directly from a victim they know. In some rare cases, insiders like insurance company employees or medical office staff might partake in fraud, but for the most part, medical identity theft isn’t distinct from any other type of identity theft in regard to how it happens. What’s made it more common, though, is the increasing digitization and automation of medical billing and insurance processing. With little more than a victim’s insurance ID and social security number, thieves often have more than enough information to place false claims for medical services.

What are the potential consequences of medical identity theft?

We’ve already alluded to the general impact that medical identity theft can have on victims. By fraudulently using someone else’s medical coverage, identity thieves may leave victims on the hook for unexpected bills. Additionally, altering someone’s medical records can cause complications as doctors might struggle to determine with accuracy what is and isn’t part of a patient’s medical history. This could result in victims being given improper prescriptions or being denied treatment altogether. What’s worse, if the complications that arise from identity theft are instead viewed as fraud by insurers, the consequences can be even more damning, affecting a victim’s future access to lifesaving insurance and care.

Preventing and dealing with medical identity theft

Unfortunately, it can be difficult to know if you’re a victim of medical identity theft, and even more difficult to prevent it. With traditional financial fraud, financial institutions typically notify you, sometimes even proactively, when something goes wrong. However, this isn’t the case for medical identity theft, as you usually only learn of it when you get a bill or a collections call about medical services you never requested or received. Fortunately, there are a few habits you can develop that help reduce your chances of experiencing medical identity theft.

Precautionary measures you can take

Monitor your medical records. As with your credit reports, you should get into the regular habit of checking your Explanation of Benefits (EOB) and any other documents provided to you by your insurance company in order to ensure that your insurance isn’t being exploited and that your medical history is still accurate. In addition to receiving mail from your insurer, consider signing up for online accounts with your insurance provider and doctor(s), assuming they’re offered. These tools will not only make it easier to monitor your information, since you can access it instantly with a few clicks, but it’ll also make it impossible for someone else to sign up for these accounts in your place.

Don’t share medical info freely. Make sure to be careful about who you share your insurance details (and other personal information, like your social security number) with. This means being very cautious when asked for your information over the phone in an unsolicited call or through any links sent to you through an unsolicited email.

Get rid of clutter. If you collect physical copies of your EOB and other medical records, make sure that you do a good job of either storing them securely or shredding them thoroughly. You will also want to be sure that your mailbox is protected to prevent anyone from stealing mail from your insurance company.

Consider signing up for identity theft protection. While they aren’t a guaranteed stopper against identity theft, these services can help you by monitoring for your personal information (including medical data, like your insurance numbers) on black market channels. They also keep an eye on your credit reports, notifying you when changes like new accounts or a significant drop in your credit scores occur. Most importantly, in the event you do become a victim of medical identity theft or any other type of fraud, you’ll have a dedicated team behind you to help navigate the process of reporting and restoring your good name. Learn more about these services and see which is right for you by checking out our identity theft protection reviews.

What to do if you’ve been victimized

If the worst happens and you find yourself victimized by medical identity theft, don’t fret. While medical identity theft can have a number of different consequences, there are specific actions you should take whenever you learn you’re a victim that will help you get control back.

Double-check your records: The very first thing you’ll want to do is to check your records with both your insurance company and your doctor(s). Your insurance should be able to provide you with something known as an Explanation of Benefits (EOB), which is a statement containing information about the medical services billed to your insurance provider. It’s not a bill, but it does show what medical procedures and services you received, what you will owe for them and what was covered by your insurance policy. If you’re the victim of medical identity theft, your EOB should show you if someone used your insurance to receive a service along with the dates of the fraud.

Aside from viewing your EOB, you should check your medical records with your primary care physician and other doctors to ensure that your medical history is accurate and hasn’t been altered in any way. You can also request what’s known as an accounting of disclosures, or a disclosure history, which is your right under HIPAA (Health Insurance Portability and Accountability Act). An accounting of disclosures will provide you with a record of when your medical records were disclosed or shared, for what reason and to whom.

If you find any inaccuracies in these records, it’s important that you correct them immediately, as they will likely affect your future care and insurance claims. Additionally, you should also regularly check your credit reports, as unfamiliar medical bills in your name that don’t get paid will eventually show up there.

Contact authorities and report the fraud. After becoming an identity theft victim, it’s important that you create a paper trail for your records. You can do this by filing a police report and submitting an identity theft report to the FTC. Doing so will help show any parties evaluating your identity theft claims that your experience is genuine. Some creditors or billing departments may require that you have a police report documenting your identity theft in order to erase fraudulent charges from your accounts. You might also be interested in reaching out to consumer watchdog organizations like the Identity Theft Resource Center for additional help.

Like other forms of identity theft, medical identity theft is something that can be devastating for victims, but is also something you can recover from. For more information regarding identity theft, continue reading our our identity theft protection blog and be on the lookout for our next identity theft 101 post.