Suspect medical identity theft? Report it!

September 24, 2018  //  FOUND IN: Updates & Resources

If you suspect a patient is involved in identity theft or medical identity theft, please notify your supervisor immediately.

If suspicion about the patient is warranted, immediately contact Hospital SecurityComplete a patient safety report and provide all pertinent information, including the patient’s name and registration number involved in the suspicious activity.

What are identity theft (ID theft) and medical identity theft?

ID theft occurs when a person’s identity or identifying information has been assumed or used by someone else to profit illegally or commit an unlawful act (e.g., using someone’s personal information to fraudulently apply for a credit card, or selling someone’s personal information).

Medical ID theft is health care fraud. This occurs when a person has attempted to or actually uses another person’s identifying information to obtain medical care (e.g., using a relative or friend’s identification to obtain medical care so the care would be paid for by the friend’s/relative’s medical insurance).

What are indicators of potential identity theft?

Identity theft is not always easy to recognize. Here are some examples of suspicious activity that may indicate possible identity theft:

Presentation or receipt of suspicious documents 

  • Patient refuses to provide name or other information required at registration for identification.
  • Patient presents identification or other identifying information suspected as false.
  • Patient complains that they received a bill, an explanation of benefits (EOB), or some other document related to medical service that they say they never received.
  • Patient reports discrepancies in medical record information — the discrepancies do not reflect the patient’s history or medical care received (e.g., patient record indicates that patient had a broken arm, but presenting patient had no actual history of broken bones).

Suspicious insurance or credit activity

  • Patient complains that insurance coverage for a hospital stay has been denied — the patient’s insurance company said that insurance benefits have been depleted or a lifetime cap has been reached — the patient tells you they never received medical care/services to that extent.
  • Complaint/inquiry from a patient about information added to a credit report by a health care provider or insurer.
  • Dispute of a bill by a patient who claims to be the victim of any type of identity theft.
  • A notice or inquiry from an insurance fraud investigator for a private insurance company or a law enforcement agency.