Risk Management: Identity Theft Awareness

Watch Out for Robin Hood – When Medical Identity Theft is an Inside Job

Roughly 1.84 million Americans have been victims of medical identity theft, according to a study by the Ponemon Institute, a privacy research center in Michigan. Medical identity theft happens when someone steals or uses another person’s information (such as their name, Social Security number, or health insurance ID number) to obtain healthcare services wrongly. Medical identity theft is a form of fraud with serious quality-of-care and financial consequences: corrupted medical records can lead to mistreatment, misdiagnosis, delayed care, or prescribing the wrong medications. Steep financial losses can follow for insurers and patients.

Here’s a surprising fact: Though medical identity theft is often committed by hackers and thieves, many identity theft cases are Robin Hood crimes. That is, the theft occurred after someone willingly shared their information with another (often a family member or a friend) who can’t obtain healthcare services under their own identity. The Ponemon study found that those who shared their health information tended to be slightly older (an average of 40.1 years compared to 36.4 years for those who did not share), from a lower-income household ($45,801 vs. $69,309), female (58 percent vs. 42 percent) and more likely to have government than commercial health insurance (31 percent vs. 21 percent).

In light of this trend, remember to authenticate patients before delivering care. Some offices use biometrics for this purpose. It’s also helpful to train staff to identify and report possible indicators of identity theft: Notice when information collected at a patient’s visit doesn’t match what’s on file about the person. Notice if tests being ordered are inconsistent with the patient’s history. Remember that patients who are who they say they are won’t usually have trouble verifying demographic data or answering simple questions about their health problems or medication history. To report potential fraud involving Neighborhood members, please call (888) 579-1551.    

Medical identity theft isn’t a victimless crime. So watch out for Robin Hood: Consider making identity theft awareness part of your risk management plan.