Of all the ways we fall victim to identity theft, truly the most devastating may be the fraudulent theft of medical benefits. Although it is the least studied and least documented form of crime, it has far-reaching and almost irreversible repercussions. Recent federal and state legislation has provided consumers with a wide range of rights and protections to combat the effects of financial identity theft. In stark contrast, victims of their “medical identity” misuse are often left without recourse and face almost insurmountable challenges as they attempt to correct fraudulent medical information.

The real damage in these cases occurs when the victim’s medical history is changed to suit the thief’s needs. Unlike your credit file(s), you do not have the same rights to correct or dispute the medical information in your file. To illustrate the point, let’s refer to the 1996 case against Dr. Richard P. Skodnek of Massachusetts. Dr. Skodnek was convicted of more than 130 counts of fraud related to false billing for Medicare and insurance. The formerly highly respected psychologist had been filing claims with his patients’ insurance providers for treatments and appointments that did not go through. In some of the cases he also claimed to treat the brothers of his patients when in fact he had not even met them. All of these fraudulently billed “sessions” and related diagnoses were documented in each victim’s personal and permanent medical record. A judge in the case reviewing the impact on victims wrote;

“The evidence suggests that once claims have been entered, they cannot be removed from the system. The most that can be done is to enter a notation in the computer records to reflect that a particular claim was false.” Y- “In addition, even if an entry is entered to show that the billing record was false, the insurance company cannot state, and therefore the entry will not reflect, whether Skodnek’s statements regarding the diagnosis, prescription drugs, and/or or the patient’s psychiatric symptoms were false.
United States vs. Skodnek, 933 F. Suppl. 1108,; 1996 US District LEXIS 9788 (DD Mass. 1996)

With this statement in mind, please remember that your medical information is also used to make other decisions about you in addition to the treatment of an illness. Victims have had their available benefit totals reduced or completely used up and have also been denied health or life insurance, security clearances, and even employment.

Detecting theft or misuse is almost as difficult as correcting your information. Some of the ways that people have discovered that they have been victimized include;

• Receive someone else’s medical bills at your address
• billing notices from agencies and attorneys for medical services they never received or from providers they never used
• notifications from insurance companies, law enforcement, or health care providers
• inaccurate information in your medical record (i.e. different blood type or allergies and illnesses that the patient does not have)
• denial of benefits or employment

Although potentially time consuming, there are some steps consumers can and should take to detect medical identity theft.

• Obtain and review a copy of your report from the Medical Information Bureau. All consumers are entitled to one free copy each year under the Fair and Accurate Credit Reporting Act (FACTA). The report includes who has reported information to the MIB, requested their file, and also the consumer’s individual insurance application activity. Visit www.mib.com for information and instructions for consumers.
• Review any “Explanation of Benefits” sent by insurers, even if your balance is $0. Contact your insurer right away if something isn’t right.
• Carefully review all statements and bills sent by health providers and insurers. Never assume errors were accidental and will be corrected. Call and dispute inaccurate entries with both the provider and your insurer.
• Annually request complete medical records and an accounting of disclosures from each medical provider you see and their insurer(s). Include any hospitals you have visited during the year for any reason. Review them carefully and promptly discuss errors.

Unlike financial identity theft, monitoring services are not available to alert you when your medical information has been accessed or altered. Detection and correction of this crime will be your responsibility for the foreseeable future. However, the best identity theft monitoring and restoration services available to consumers will include valuable assistance if you are a victim of this type of theft. The best advice for consumers is to educate yourself and carefully monitor your information and claims. Lastly, seriously consider a top-notch identity theft service for your family that specifically addresses this crime.