Medical Identity theft is Often an Inside Job

Asking patients for photo IDs is one safeguard, but many thefts are also committed by health care employees.

When physicians look to protect their patients from medical identity theft, they may want to start by examining their office staff.

That's because, while patients may try to use another person's identity fraudulently to receive medical care, many thefts happen when a hospital, clinic or practice employee sells patient information to organized crime or gang leaders, experts said. Then the information is used to conduct fake billing or obtain goods such as wheelchairs and prescription drugs to sell on the black market, said Pam Dixon, executive director of the World Privacy Forum, a nonprofit research and consumer education organization.

The forum is conducting its second study of medical identity theft, and the findings will be released later this year. In its first study, issued in 2006, the organization reported that 250,000 to 500,000 people had experienced this form of identity theft.

A 2007 study by the Federal Trade Commission estimated that medical identity theft affected about 250,000 people in 2005.

"We have the anecdotal information that it is increasing," Dixon said, noting that cases involving individuals committing the crime alone are rare. "We do see some of that where someone steals a wallet or they steal someone's name. That does happen. But the preponderance of cases are happening from insider jobs."

Dixon points to a case at the Cleveland Clinic in Weston, Fla., where Isis Machado, a front-desk office coordinator, pled guilty to selling information involving more than 1,000 patients. Although the hospital had browser controls to limit the number of records that employees could view, no one noticed Machado was exceeding that limit regularly, Dixon said. Machado's case resulted in $7 million in Medicare fraud. MORE

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Health Care Providers Not Required To Notify Patients Of Compromised Records

Identity theft is a widespread and well-publicized problem with huge financial repercussions, but a hole in the nation's notification laws could potentially prove lethal. There is no law requiring health care providers to inform patients when they learn that a thief may have accessed their health records.

One such breach was revealed last November when police said a ring of identity thieves had spent more than eight months pilfering patient records at Columbia St. Mary's Ozaukee Hospital.

In that incident, the band of ex-cons depended on a housekeeper at the hospital to provide them with the information they needed to get online loans in patients' names. MORE

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There are two facets to medical identity theft; one is financial and the other involves your health care. Medical identity theft happens when a thief uses your social security number or health insurance to obtain medical services, health benefits -including prescriptions, without your knowledge. Medical identity theft can carry with it damaging, far-reaching effects. Not only is medical id theft hard to detect, it is even more difficult to correct than the more commonly heard of -financial identity theft.

Victims of medical identity theft have found their medical histories contaminated with false diagnosis, billings for surgeries they never had, prescriptions they never received and bogus allergies and blood type notations that are all frighteningly wrong and belong to someone else -the thief!

The World Privacy Forum has informative frequently asked questions and answers on their website -take the time check it out -it's very informative.

Resources

* If you suspect you have been the victim of Medicare/Medicaid fraud, call 1-800-HHS-TIPS (1-800-447-8477).

* You can also file a medical identity theft complaint at the FTC, and take advantage of their excellent resources on resolving the financial aspects of medical identity theft. .

By phone: call the FTC Identity Theft Toll-Free Hotline at 1-877-IDTHEFT (438-4338).

* If a health care provider has not allowed you to see your own medical records, file a complaint with the Office of Civil Rights at Health and Human Services at or 1-800-368-1019.

* The Blue Cross/Blue Shield has an excellent page of tips for preventing fraud problems.

Blue Cross/ Blue Shield recommends that you should be cautious of free medical exams, co-payment waivers, or advertisements stating "covered by insurance." They also recommend that you think of your healthcare card as being as valuable as a credit card. "If lost or stolen, a healthcare card could be used to gain access to drugs and services that may permanently appear on your medical history."

* You can find more information about your health privacy rights at the web site of the Health Privacy Project
* The web site of the Georgetown University Center on Medical Record Rights and Privacy at has information on state laws about access and correction of medical information.

* Many insurers have fraud hotlines. If you suspect medical identity theft, call your insurer and ask for their fraud hotline number.