Of all the ways we are victims of 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 the misuse of their “medical identity” 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 fraud charges related to false Medicare and insurance billing. The previously highly respected psychologist had been filing claims with his patients’ insurance providers for missed treatments and appointments. In some of the cases he also claimed to treat the siblings of his patients when in fact he had never even met them. All of these fraudulently billed “sessions” and related diagnoses were documented in each victim’s permanent personal medical record. A judge in the case reviewing the impact on victims wrote;

“The evidence suggests that once claims are entered, they cannot be removed from the system. The most that can be done is to enter a notation in the computer logs to reflect that a particular claim was false.” AND- “Furthermore, even if a notation is entered to show that the billing record was false, the insurance company cannot state, and therefore the notation will not reflect, whether Skodnek’s statements about diagnosis, prescription drugs, and/or or the patient’s psychiatric symptoms were false.”

United States v. 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 decisions about you other than treatment for a disease. Victims have had their available benefit totals reduced or fully utilized 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 lawyers 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 diseases 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 Office. 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 individual consumer 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 immediately if something is not correct.
• Carefully review all statements and invoices sent by health providers and insurers. Never assume that mistakes were accidental and will be corrected. Call and dispute inaccurate entries with both the provider and your insurer.
• Request complete medical records and an accounting of disclosures annually from each medical provider you see and your insurer(s). Include hospitals you have visited during the year for any reason. Please review them carefully and immediately discuss any errors.

Unlike financial identity theft, monitoring services are not available to alert you when your medical information has been accessed or altered. Detecting and correcting this offense 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 identity theft. The best advice for consumers is to educate themselves and carefully monitor their information and statements. Finally, seriously consider a top-rated identity theft service for your family that specifically addresses this crime.