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Fraud & Identity Theft

How Can Medical Identity Theft Occur?

Medical identity theft refers to the theft of your personal medical information—and when scammers fraudulently use it to get medical products, services and insurance payments. It can occur after your wallet is stolen, when your account is hacked or if someone with legitimate access to your information, such as an employee at your clinic, takes advantage. It's also possible for information to be caught up in a health care-related data breach—in 2020 alone, 817 data breaches exposed consumer medical information of some kind, according to the Identity Theft Resource Center.

Types of Medical Identity Theft

Medical identity theft can fall under different categories depending on who uses your information to perpetuate the fraud.

  • Outsider fraud describes a scenario in which someone else uses your personal and medical information without your knowledge. The fraudster may have stolen your information themselves or bought it from someone who did.
  • Insider fraud is when someone within the health care system fraudulently uses a patient's information. For example, a doctor who adds a false diagnosis to your medical record and then bills your insurance provider for the "treatment."
  • Friendly fraud is when you knowingly allow someone else, such as a friend or family member, to fraudulently use your information.

While you never want to fall victim to any type of identity theft, medical identity theft can be particularly troublesome. Once someone has your personal and health insurance information, they may be able to:

  • Get a medical procedure or test in your name.
  • Use your information to buy prescription drugs and medical equipment.
  • Make fraudulent insurance claims.

These can lead to the costly and time-consuming task of proving you were the victim of fraud and fixing your financial, credit, health and possibly criminal records. Even friendly fraud, which might not have financial repercussions, could be dangerous.

Incorrect medical and insurance records can also lead to life-threatening mistakes and delays. A doctor may give (or withhold) medications or treatments based on a medical record that contains fraudulent information. Your insurance company could also deny necessary treatments or medications due to the fraudulently filed claims.

How to Prevent Medical Identity Theft

In many ways, protecting yourself from medical identity theft can be similar to what you might already be doing to reduce the risk of other forms of identity theft.

For example, creating a unique and secure password for all your accounts can help minimize the fallout of a data breach at one company. Additionally, monitor your credit for hard inquiries (an indication that someone has applied for credit), new accounts and collections accounts that could be an indication your personal information has been compromised.

Steps you can take to prevent medical identity theft, in particular, include:

  • Look for notices from health care companies, including your insurance, doctor, pharmacies and clinics.
  • If you lose your health insurance card, request a new card with a different number.
  • Shred or safely dispose of health records and documents that have your personal information.
  • Never share your personal information, including health plan information, over the phone or by email if you didn't initiate the conversation.
  • Don't share your information with people and companies that promise to give you free products or services.
  • If you submit your information online, make sure the website has "HTTPS" at the beginning of the URL (sometimes indicated by a closed-lock symbol or the word "secure").
  • Create your patient portal account if your health care provider offers an online service.
  • Keep your computer's antivirus and anti-malware software updated.
  • Review your medical records annually.
  • Hold on to copies of old medical records and other documents because they may be needed to fix your record if you're the victim of medical identity theft.

What to Do if You Think You're a Victim of Medical Identity Theft

Even with every precaution in place, your information could still be compromised due to a data breach. You could also be the victim of insider fraud, or a fraudster may get hold of your information in spite of the safety measures.

Signs of medical identity theft can include getting a bill or an explanation of benefits (EOBs) from your insurance company for a service or product you didn't receive, or noticing an error in your medical records or credit report.

If you know or suspect you've been the victim of medical identity theft:

  • Submit a report to the Federal Trade Commission (FTC), which will create a recovery plan and give you an FTC Identity Theft Report. If you create an account, the FTC can auto-fill forms and track your progress online. You might also want to file a crime report with your local law enforcement.
  • Look into adding a fraud alert or fraud alert or credit freeze. Doing so can help keep fraudsters from using your information to open new credit accounts.
  • Request copies of your insurance EOB statements and medical records to review them for errors.
  • If you find something amiss, contact the appropriate provider to inquire or request that they update your records.

Cleaning up after an incident of medical identity theft can be time-consuming, but quickly taking action can also help prevent further issues.

Get Help Monitoring and Correcting Your Identity

Identity theft protection services can monitor multiple databases, including your credit reports, public records and the dark web, for your personal information. The early warning can help you take steps to secure your identity and let you know that you need to be extra vigilant about checking your records.

If fraudsters are able to use your stolen personal information, some services can also help you with the recovery process and cost. The Experian IdentityWorksSM Premium program, for example, includes up to $1 million in identity theft insurance and can help you with costs related to child care, lost wages and legal consultation. You'll also be connected with a U.S.-based fraud resolution specialist. The extra assistance this program provides can save you time and defer some of the costs that can result from identity theft.