Unhealthy Procedures

Medical Identity Theft

By Martin T. Biegelman, CFE, CCEP, ACFE Fellow

2009-SeptOct-Medical ID Theft 

Imagine Linda Weaver's shock in 2007 when she received a hospital bill for the amputation of her right foot. She didn't need to look down at her two intact feet to know that this was bunk.

She soon discovered an identity thief had stolen her Social Security number (SSN) and insurance identification number. Posing as Linda Weaver, the fraudster had the costly amputation performed. To make matters far worse, Weaver later found that the thief's medical information was merged into her medical file. Her medical chart now listed her as having diabetes – the criminal's condition, not hers.

Just think of all the life-threatening complications she or anyone else in this situation could potentially face. The wrong blood type listed in the file, not documenting a heart condition, and allergies or intolerance to certain medication can result in trauma or death. "I now live in fear that if something ever happened to me, I could get the wrong kind of medical treatment," said a clearly troubled Weaver in the article, "Diagnosis: Identity Theft," by Dean Foust in the Jan. 8, 2007, issue of BusinessWeek.

As more health records are computerized and made available to medical providers on the Web, more data breaches and medical record compromises will occur.

The U.S. Federal Trade Commission (FTC) in its pamphlet, "Fighting Back Against Identity Theft," defines medical identity theft as occurring "when someone uses your personal information without your knowledge or consent to obtain, or receive payment for, medical treatment, services, or goods. Victims of medical identity theft might find that their medical records are inaccurate, which can have a serious impact on their ability to obtain proper medical care and insurance benefits."

The FTC's 2006 Identity Theft Survey Report provided key findings on medical identity theft. Three percent of all identity theft victims indicated that a fraudster had obtained medical treatment, services, or supplies using their stolen personal information. That translates to approximately 250,000 victims for calendar year 2005.

Anyone who receives medical care can potentially become a victim, however, "people 50 and older are at the greatest risk because they often have some kind of government-issued insurance, such as Medicare or Medicaid," states Pam Dixon, executive director of the World Privacy Forum, in the article, "Stealing Your Health," by Sid Kirchheimer in the September 2006 issue of the AARP Bulletin. The World Privacy Forum is a nonprofit research and consumer education organization that closely monitors medical identity theft.

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