Medical Identity Theft: Defence & Prevention Measures

When someone steals your personally identifiable information (PII), which can include your health insurance number, name, Social Security number, or prescription identity, to receive medical care or services and/or to submit fraudulent healthcare claims, this is medical identity theft. 

Medical identity theft can cost patients an average of $13,500 to resolve. It can also interfere with your medical care and medical records, as someone else has been using your benefits.

It is very important to keep your protected health information (PHI) secure, as it is highly valuable on the black market. Bad actors can use this information to fill prescriptions, obtain medical care through Medicare or Medicaid, or commit insurance fraud. 

Medical identity theft is a serious concern with potentially significant health and financial ramifications. The best way to combat medical identity theft is through preventative measures.

What is medical identity theft?

Medical identity theft is a type of identity theft where someone uses your personal identity information to obtain medical care, services, or prescriptions, or to file fraudulent health insurance claims. 

Your PII can include the following:

• Full name
• Birth date
• Social Security number
• Health insurance number
• Medicare or Medicaid coverage number
• Prescription identity information

With this information, a fraudster can commit medical identity theft in the following ways:

• File a fraudulent insurance claim.
• Obtain healthcare services or Medicare or Medicaid services.
• Fill and purchase prescriptions.
• Obtain medical equipment.

Medical identity theft is especially dangerous since it can disrupt and interfere with your personal healthcare needs. For example, you can reach your annual maximum coverage amounts without ever filing a claim personally. Then, when you need care, you could be denied coverage and therefore unable to afford the care you need. 

It could lead to a medical emergency, as medical identity theft can create errors in your medical records. This can cause you to get the wrong treatment or necessary care, which can be disastrous in the event of an emergency. 

You could also end up with criminal charges if fraudsters use your personal health information to purchase large quantities of pharmaceuticals. 

Protecting your prescription identity

To keep fraudsters from stealing your prescription identity and using it to obtain unauthorised prescriptions (often while sending your insurance company the bill through a fraudulent insurance claim), you need to keep your personal and sensitive healthcare information safe from potential threats. This does not always mean a stranger, as around half of medical identity theft is perpetrated by family members. 

It is important not to share your personal medical information with anyone. This includes online or over the phone. Be very careful when sharing personal medical information, and only do so when you initiate the conversation. Go directly to healthcare sites, and do not open attachments or click on links sent via email.

Keep any and all documents containing your medical information secure, such as these:

• Prescription bottles
• Health insurance cards
• Billing statements from medical providers
• Prescriptions
• Explanation of benefits (EOB) statements from your health insurance provider
• Health insurance enrollment forms

When you need to dispose of these documents, shred them first. For prescription bottles, black out all personal identifiable information. Consider moving your mailing preferences to electronic to prevent possible mail theft. If you lose your health insurance or prescription card, or it is stolen, report this right away and request a new health insurance or prescription identification number immediately.

Best practices for preventing medical identity theft

Medical identity theft is complicated to unravel and resolve. Often, the best practices for managing medical identity theft are in prevention. Here are some tips to follow:

• Understand what measures healthcare providers are taking to keep your medical records and sensitive PII safe. Hackers often target medical information to sell on the dark web. As a result, it is important that this data is kept securely and within regulatory compliance.
• Keep an eye on your healthcare records, and pay attention to any communications or bills from your insurance, pharmacy, or healthcare providers. Look for unknown claims or suspicious activities in your medical records, insurance bills, credit, and explanation of benefits.
• Perform an annual check of your medical records and monitor your credit. Fraudsters will leave medical bills unpaid, so it is possible for these to go into collections and negatively impact your credit. Make sure that your medical records are accurate and that there is nothing out of the ordinary showing up, such as a preexisting condition that you do not have that can get yo