Consumer Affairs Branch Fairfax County Department of Cable and Consumer Services

fairfaxcounty.gov/consumer

Medical Identity Theft

Medical identity theft happens when someone steals your personal information and uses it to commit health care fraud.

What is Medical Identity Theft?

An individual has no health insurance, but needs treatment, surgery or prescription drugs and uses your medical information to obtain those services

People working in a medical setting submit false bills to collect money

An individual may steal someone’s identity to hide pre-existing medical conditions from employers or insurance providers

Examples of Medical Identity Theft

A record is created in your name with the imposter’s medical information

◦ Individual and family medical history

◦ Blood type

◦ History of smoking and drug or alcohol use

◦ Lab test results

◦ Diagnosis of illness, allergy, diseases or other conditions

◦ Prescriptions

What Happens When Thieves Use Your Medical Identity?

You receive a bill for medical services you didn’t receive

A debt collector contacts you about medical debt that you don’t owe

You see unrecognizable medical collection notices on your credit report

How Do You Know If You Are A Victim of Medical Identity Theft?

Your health insurance denies a legitimate medical claim because you’ve reached your limit on benefits

You are denied insurance because your medical records show a condition you don’t have

How Do You Know If Your Are A Victim of Medical Identity Theft?

Verify a source before sharing information

◦ Don’t give out personal information on the phone or through the mail unless you’ve initiated the contact

◦ Be wary of offers of “free” health services or products from providers who require you to give them your health plan ID number.

An Ounce of Prevention

Safeguard your medical and health insurance information

◦ Keep copies of your medical or health insurance records secure

◦ If asked to share your social security number or, insurance account information or other details – ask WHY?

◦ Be on guard when using the internet. Read website privacy policies and make sure the site is secure

An Ounce of Prevention

Treat your trash carefully

◦ Shred health insurance forms and prescription and physician statements

◦ Destroy labels on your prescription bottles and packages before throwing them out

An Ounce of Prevention

Read the Explanation of Benefits (EOB) statement

◦ Medicare beneficiaries – read Medicare Summary Notice

◦ Make sure claims match the care you received

◦ Verify the name of the provider, the date of service and the service provided

◦ If there is a discrepancy – contact your health plan to report the problem

Detecting Medical Identity Theft

Keep track of communications with health plan and providers◦ Postal and email correspondence◦ Phone calls, conversation and activities

Order a copy of your credit reports ◦ Review carefully◦ Law requires each reporting agency to provide a

free report annually if you ask for it

Detecting Medical Identity

Annual Credit Report Request Service P.O. Box 105281

Atlanta, GA 30348-5281

www.AnnualCreditReport.com

1-877-322-8228

www.ftc.gov/freereports

Annual Credit Report Request

Ask for a copy of your medical records ◦ The Health Insurance Portability and Accountability Act

(HIPAA) Privacy Act Rule

◦ Right to copies of your records that are maintained by health plans and medical providers covered by the law

◦ Required to give you your files within 30 days after you ask for them

◦ Make a request to each provider

Detecting Medical Identity Theft

Make a request to each provider◦ Doctors ◦ Clinics◦ Hospitals◦ Pharmacies◦ Laboratories◦ Health Plans

A written request and a fee for the records may be required

Detecting Medical Identity Theft

If you are denied access to your records – you must be provided a reason in writing

◦ You have the right to appeal if your request is denied

◦ Contact the Person identified in the Notice of Privacy Practices

◦ US Department of Health and Human Services’ Office for Civil Rights – www.hhs.gov.ocr

Detecting Medical Identity Theft

Obtain a copy of the accounting disclosures for your medical record◦ Date of the disclosure◦ Name of the person or entity who received the

information◦ Brief description of the information disclosed◦ Brief statement of the purpose of the disclosure

The law allows one free copy of the accounting from each of your providers every 12 months

Detecting Medical Identity Theft

U.S. Department of Health and Human Services, Office of Civil Rights at www.hhs.gov/ocr

World Privacy Forum at www.worldprivacyforum.org/FAQ_medical recordprivacy.html

Your Rights Under HIPAA

File a complaint with the Federal Trade Commission◦ https://www.ftccomplaintassistant.gov ◦ 1-877-ID-THEFT (438-4338)◦ TTY 1-866-653-4261

Bouncing Back from Medical Identity Theft

File a report with your local police◦ Send copies of the report to

your health plan’s fraud department Your health care provider(s) The three nationwide credit reporting companies

More information about how to file a police report is at www.ftc.gov/idtheft/consumers/defend.html

Bouncing Back from Medical Identity Theft

Exercise your right under HIPAA to correct errors in your medical and billing records◦ Write to your health plan or provider detailing the

information that seems inaccurate

◦ Include copies (keep originals) of any document that supports your position

◦ Identify each item in your record that you dispute

◦ State the facts and reasons for disputing the information

◦ Request that each item be corrected or deleted

Bouncing Back from Medical Identity Theft

Exercise your right under HIPAA to correct errors in your medical and billing records

◦ Request that each item be corrected or deleted

◦ You may want to include a copy of your medical record with the items in question circled

◦ Send your letter by certified mail and ask for a “return receipt”

◦ Keep copies of the dispute letter and enclosures

Bouncing Back from Medical Identity Theft

Generally the health plan or medical provider must respond

◦ The creator of the information is obligated to amend the inaccurate or incomplete information

◦ It should notify other parties, like labs or other health care providers, that they may have received incorrect information

◦ If the investigation does not resolve your dispute – request that a statement of the dispute be included in your record

What to Expect After You Submit Your Dispute

Fraud Alert – can help prevent an identity thief from opening additional accounts in your name

Contact each of the three nationwide credit reporting companies◦ TransUnion ◦ Equifax◦ Experian

Other Steps to Consider

Security Freeze – also known as a credit freeze, is a warning to businesses or others who may use your credit file. It locks down your credit file and blocks access by potential creditors ◦ Does not affect your credit score◦ Does not keep you from obtaining your free

annual credit report◦ Does not keep your from buying your credit report

or score It can be temporarily lifted or removed by

request

Other Steps to Consider

Center on Medical Record Rights and Privacy

Health Policy InstituteGeorgetown University Box 57144Washington, DC 20057-1485202-687-0880

http://ihcrp.georgetown.edu/privacy/records.html

Resources

World Privacy Forum2033 San Elijo Avenue, #402Cardiff by the Sea, CA 92007760-436-2489www.worldprivacyforum.org

Resources

U.S. Department of Health and Human Services

Office of Civil Rights 200 Independence Avenue, SWWashington, DC 20201www.hhs.gov/ocr

Resources

www.fairfaxcounty.gov/consumer

Medical Information Bureau (MIB)Has records of individuals that have applied

for individual insurance in the last seven years with an MIB Member

Get a copy of your MIB consumer file annually without charge

Phone 866-692-6901TTY 866-346-3642

Resources

www.fairfaxcounty.gov/consumer

Fairfax County Financial Crimes Division of the Fairfax County Police Department

703-246-7800

http://www.fairfaxcounty.gov/police

Resources

www.fairfaxcounty.gov/consumer

Virginia Department of Health ProfessionsEnforcement Division6603 West Broad Street, 5th FloorRichmond, VA 23230-1712800-533-1560804-662-7079www.dhp.virginia.gov

Resources

www.fairfaxcounty.gov/consumer

Questions

Fairfax County Consumer Affairs Branch

12000 Government Center Parkway, Suite 433Fairfax, VA 22035

703-222-8435www.fairfaxcounty.gov/consumer