Preventing Medical Identification Theft

By Richard Asa @RickAsa
December 07, 2015

Be aggressive about checking your credit and medical records, and hold your healthcare providers accountable.

While you’re probably more worried about who might be using your credit cards, your medical identity might be stolen right from under your nose. 

Medical identity thefts increased by nearly 22 percent in one year (2014), according to an annual study released in February 2015.

It’s costly. Sixty-five percent of medical identity theft victims in the study paid an average of $13,500 to resolve the crime. 


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“In some cases, they paid the healthcare provider, repaid the insurer for services obtained by the thief, or they engaged an identity service provider or legal counsel to help resolve the incident and prevent future fraud,” the study said.

The victim is not only you; medical identify theft affects healthcare providers, insurance companies, taxpayers, and other consumers, who as a result pay more for healthcare.

Medical identify theft is also a complicated crime to solve and is time consuming. For all the cases resolved, many more aren’t, meaning that potentially devastating information is floating around out there. 

That all makes it worth being acutely aware of how your medical identify is being protected. Or if it’s being protected.

Medical identity theft is defined as having your personal health information (without your knowledge or consent) used to “obtain, or receive payment for medical treatment, services, or goods,” according to the American Health Information Management Association (AHIMA).

Often, AHIMA says, it involves deliberate errors placed in existing medical records, and can center on the creation of fake medical records in your name. Like credit card fraud, this trail of “falsified information” in your medical records can haunt you for years, “or even put your health at risk” if you are denied treatment as a result. 

It’s most likely that family or friends with access to your medical records are the perpetrators, the study found. But, increasingly, financial fraud hackers are stealing medical records because it’s lucrative. 

If they can get your medical credentials, says Rick Kam of ID Experts, they’ll order health services and goods, bill organizations like Medicare and Medicaid, and make more money from that than from “drugs, prostitution, and other crimes they may pursue.”

Further, 45 percent of people in the annual study said medical identity theft hurt their reputations, mostly from embarrassment over the disclosure of sensitive personal health conditions. Nineteen percent believed the theft created obstacles to career advancement, and 3 percent said they lost their jobs because of it. 

You probably believe your healthcare provider should be “proactive” in preventing and detecting medical identity theft. Yet, the study found that 68 percent are “not confident” their healthcare providers are actually protecting their medical records from loss or theft. 

The public’s concerns seem well founded. “Unlike the financial services industry, health care companies lack measures to adequately prevent identity theft, even as they continue to digitize medical records and other sensitive information,” says a Fortune magazine report. 

You have to counter that lack of confidence with constant vigilance and awareness of how your medical records and identification are being used and protected. First, you have to ask all your healthcare providers, including insurers, what they have in place for security. Most people don’t. 

That means doing your own homework and monitoring your health records closely, addressing any errors quickly, and sharing personal and health insurance information only with “trusted providers,” AHIMA advises. 

In addition you should pay close attention to the explanation of benefits from insurers and get an annual summary of all benefits paid. 

You should also contact the insurer or provider about charges for care that were not received, even when there is no money owed, AHIMA says. Keep copies of all your health care records. 

Don’t be drawn in by any offers of “free” medical treatment. There’s a good chance that someone just wants to obtain your name and insurance information. 

Protect your insurance cards, explanation of benefits, and health plan correspondence in the same way you would safeguard your credit cards, AHIMA says. 

These precautions are critical because the Fortune report says the “healthcare industry is failing us” when it comes to medical identify theft. 

One hospital system alone had 4.5 million medical records stolen in 2014 by hackers. 

Larry Ponemon, chairman and founder of the institute that did the consumer medical identification study, agrees with many other experts. He says the financial industry is way out ahead of the healthcare industry in protecting consumers against fraud.

In 2014, a consortium of various players in the healthcare industry formed the Medical Identity Fraud Alliance to help address system-wide issues that would establish best practices against medical identification fraud. 

But that still leaves you out there to fend for yourself in the meantime. So, be aggressive about checking your credit and medical records. Try to hold your healthcare providers accountable, and try to make sure your medical records are where they’re supposed to be. If someone says they don’t know where they are, start pushing harder. 


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April 06, 2020

Reviewed By:  

Janet O’Dell, RN