Posts Tagged ‘Medical IdentityTheft’
Medical Identity Fraud Alliance: A Call to Action by ITRC
The Medical Identity Fraud Alliance has recently published its first whitepaper titled, The Growing Threat of Medical Identity Fraud: A Call to Action, focusing much needed attention on the urgent issue of medical identity theft and fraud.
MIFA is the first public/private sector-coordinated effort with a focused agenda that unites all the stakeholders to jointly develop solutions and best practices for fighting medical identity fraud. The whitepaper defines medical identity fraud as the fraudulent use of an individual’s protected health information (PHI) and personally identifiable information (e.g., name, Social Security number) to obtain medical goods and service or to gain financial benefit. Medical identity theft is defined as the stealing of an individual’s protected health information.
The number of medical identity theft victims in the United States has increased from 1.42 million in 2010 to 1.85 million in 2012 and healthcare fraud, which almost always requires medical identity theft to commit the fraud, costs the United States at least $80 billion a year. Medical identity theft and fraud is much more complex and difficult to mitigate than the much more publicly known financial identity theft and fraud. Because criminals can monetize medical identities 20 to 50 times better than a financial identity, the value of a medical identity can be up to 50 times greater than a Social Security number alone. The high value of medical identities motivates criminals to put more effort in illegally attaining medical identities resulting in more and more cases of medical identity theft. As more and more PHI is being converted from paper health records to electronic health records (EHR) to improve information sharing and accessibility, the PHI becomes increasingly vulnerable to data breaches.
In the paper, MIFA stresses that the individual must be the first line of defense to medical identity theft and fraud. Lessons can be learned from the credit card industry and how they handled financial identity theft and fraud. They started off by sharing fraud data and developing sophisticated analytics to identify potentially fraudulent credit card transactions, but also began verifying the flagged transactions with the consumers themselves. This process inducted the consumer into the fight against fraud and helped the credit card industry crack down on fraud. The equivalent cooperation between the healthcare industry and the consumer is to send an Explanations of Benefits (EOB) about 30 days after a medical service is provided, but people rarely actually read them and when they do, they rarely understand them. Therefore, EOBs are for the most part ignored and the communication between the consumer and the healthcare industry is broken making it difficult for insurance plans to identify a fraudulent claim quickly.
MIFA believes that in order to correctly mitigate the medical identity issues facing the healthcare industry today, there needs to be a coordinated approach between key stakeholders from the healthcare industry, security, compliance and privacy companies, government, law enforcement, nonprofit organizations, and academe. MIFA was formed to bring together stakeholders from each industry and provide leadership to:
- Develop an awareness, education, and training campaign for the public and the healthcare industry.
- Inform public policy decision makers about medical identity theft and fraud and its current and evolving impact through awareness, education, and research programs.
- Establish a comprehensive applied research agenda.
- Promote and encourage innovative best practices, processes, and technology to prevent and detect medical identity theft and fraud.
Several key stakeholders, including the ITRC, founded MIFA and have already begun this process, but more stakeholders, cooperation and information sharing are needed. Visit the Medical Identity Fraud Alliance website and see how you can help!
“Medical Identity Fraud Alliance: A Call to Action” was written by Sam Imandoust, Esq. He serves as a legal analyst for the Identity Theft Resource Center. We welcome you to post/reprint the above article, as written, giving credit to the author and click here for linking back to the original posting.
Protecting Your Medical Information from Identity Theft
Have you thought medical identity theft wouldn’t happen to you? Is your thought “why would anyone want my medical information?” Well, they don’t want your “medical history” — they want your insurance information. They might be out of work, or have a friend who needs assistance, or belong to an identity theft ring, and is in it for the money they can earn by selling your medical identity! Today it is more valuable then just your social security number.
When your medical information is stolen and used by someone to seek treatment, your own medical history will change. You may receive bills from doctors you have never seen or even heard of. You may discover they have a different blood type, or have cancer. Then to remove the mis-information and change your information back to who ‘you really are’ becomes an arduous task in itself. Also, you might find yourself responsible for bills that are not yours, and this affects your credit rating when it goes to collections!
Be proactive, protect your medical identity by asking your physician the following questions:
Does s/he do a complete background check on his employees?
Does s/he encrypt the records in his office?
If you should change physicians, what happens to those records? Does s/he outsource billing and receivables and if so, are they cleared as well. You want to know who is in his office and if there are prying eyes or someone who can walk off with all your information on a device such as a laptop or flash drive with all your electronic health information?
Read this article from Fox Business News and see why your medical information and insurance are a valued resource in the the black market; and why it is so difficult to keep your information PRIVATE: http://www.foxbusiness.com/on-air/willis-report/blog/2013/05/21/protect-yourself-against-medical-identity-theft..
And then call me or email me for solutions available to protect and recover your identity in the event that your identity is compromised or stolen
310-831-4400
Medical Identity Theft: Will you be the next victim?
Preventing Medical ID Theft: Are You At Risk ?
Preventing medical ID theft has become a hot topic as Americans increasingly hear about the safety of their private medical records as more medical breeches continue to be discovered. Medical ID theft happens when a person uses someone’s identity to obtain medical services or steal money by falsifying claims for medical services. Identity thieves use a person’s Social Security number, insurance information, or other forms of identification to commit the medical ID theft.
Medical ID theft can have a devastating effect on victims, causing collections issues, credit problems, and even bankruptcy. But that’s not all. The type of medical treatment obtained by the identity thief can also prevent the victim from getting medical insurance or medical services themselves because, as far as the insurance company is concerned, the victim now has a “pre-existing” condition.
According to the FTC, medical ID theft accounts for three percent of all ID theft cases, or approximately 250,000 cases per year. Unfortunately, these medical ID theft statistics are expected to grow, especially with the shift to electronic medical records.
Preventing Medical ID Theft: The Unemployed and Uninsured
Due to their difficult circumstances, some groups are at a higher risk for becoming identity thieves. The unemployed and uninsured may use another person’s identity because of a belief that it’s the only way they can receive quality medical care. Since they’re unemployed, they don’t have access to an employer’s healthcare benefits, and they can’t afford to buy medical insurance because they don’t have a job. It’s a vicious cycle, and it can make good people do bad things.
Preventing Medical ID Theft: Illegal Immigration
Illegal immigration also poses a serious threat as medical ID theft continues to rise. When an illegal immigrant steals private information such as an individual’s Social Security number, he or she can obtain identification and numerous services reserved for legal residents. If precautions aren’t taken to prevent medical ID theft, an illegal immigrant can get a passport, driver’s license, bank account, credit card, loan, mortgage, insurance, medical treatment, and many other services.
Preventing Medical ID Theft in Five Steps
Begin preventing medical ID theft by following these five easy steps:
1. Have your Social Security number removed from your insurance records. If your Social Security number is currently on your insurance card, don’t carry your card with you. Keep it in a safe place and only carry a photocopy with all but the last four digits of your Social Security number blacked out.
2. Obtain copies of your credit reports, insurance claims, and medical records. Lock them in a safe or safety deposit box, or place them on a CD or flash drive.
3. Next, regularly review your credit reports, insurance claims, and medical records for suspicious entries, such as a medical treatment that was never performed on you.
4. Immediately address disputes on your explanation of benefits, bills for medical services you never received, or any other charges that could be sent to collections and damage your credit. These need to be investigated and removed from your records.
5. Don’t leave a paper trail. Destroying sensitive information you no longer need is another critical step in preventing medical ID theft, so shred claims that are more than seven years old. Also, ask if your provider’s office performs background checks employees to prevent medical ID theft rings and stolen medical information.
Preventing medical ID theft takes vigilance. Medical ID thieves are doing everything to stay one step ahead of you and the authorities, so use medical ID theft prevention strategies to protect your private information.
Want to learn more about preventing medical ID theft? Contact The Identity Advocate at 310.831.4400 or via email at info@theidentityadvocate.com.
Visit us online at www.theidentityadvocate.com.
Medicare Fraud and Identity Theft – walking hand in hand DOJ Press Release
Department of Justice Press Release
For Immediate Release
March 29, 2011 U.S. Department of Justice
Office of Public Affairs
(202) 514-2007/TDD (202) 514-1888
Los Angeles Woman Pleads Guilty to Participating in a Medicare Fraud Scheme Using Fraudulent Medical Clinics and Stolen Doctor Identities to Defraud Medicare of More Than $6.2 Million
WASHINGTON—A Los Angeles woman has pleaded guilty to using fraudulent medical clinics and the stolen identities of physicians to defraud Medicare of more than $6.2 million, the Departments of Justice and Health and Human Services (HHS) announced.
Carolyn Ann Vasquez, 46, pleaded guilty yesterday before U.S. District Judge Terry J. Hatter Jr. in the Central District of California. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. According to court documents, physician assistants recruited to work at the clinics by Vasquez and working at her direction performed these services and prescribed and ordered the wheelchairs, medical equipment, and diagnostic tests.
According to court documents, Vasquez told the physicians she recruited that they would be the medical directors of the clinics, but that if they did not want to work full time, the clinics would hire physician assistants. Vasquez assisted the physicians in obtaining Medicare provider numbers and entering into management agreements that gave Vasquez’s co-conspirators authority to operate and manage the clinics in exchange for 75 percent of the reimbursement payments the physicians received from Medicare.
According to court documents, Vasquez’s involvement in the recruitment of the physicians gave her access to their personal and Medicare information, which Vasquez stole to further the fraud scheme at the medical clinics. Vasquez admitted that in approximately 2007, a physician contacted her about a job at one of the fraudulent medical clinics, but the physician decided not to accept the job. Nevertheless, Vasquez’s co-conspirators printed prescription pads with the physician’s name and Medicare provider number on them. Vasquez admitted that she instructed a physician assistant working at one of the fraudulent medical clinics to use the prescription pads to write fraudulent prescriptions and medical documentation for diagnostic tests, power wheelchairs and other medical equipment in the physician’s name even through Vasquez knew that the physician did not work at the clinic. Vasquez admitted that as a result of her conduct, Medicare was defrauded of approximately $6,268,899.
At sentencing, scheduled for July 11, 2011, Vasquez faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in court documents in this case, Vasquez pleaded guilty in 1993 to participating in a health care fraud scheme. According to court documents, Vasquez and others used telemarketing or “boiler room” schemes to defraud government-funded health care benefit programs of approximately $41 million.
The guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney André Birotte Jr. for the Central District of California; Tony Sidley, Assistant Chief of the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse; Glenn R. Ferry, Special Agent-in-Charge for the Los Angeles Region of the HHS Office of Inspector General (HHS-OIG); and Steven Martinez, Assistant Director in Charge of the FBI’s Los Angeles Field Office.
The case is being prosecuted by Trial Attorney Jonathan T. Baum of the Criminal Division’s Fraud Section. Former Special Trial Attorney Joseph Hudzik participated in the prosecution. The case is being investigated by the FBI.
The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, strike force operations in nine districts have charged 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about HEAT, go to: www.stopmedicarefraud.gov.
Press Releases | Los Angeles Home
AAPPO Conference ~ Linda Vincent of The Identity Advocate presenting
There will a 1/2 day conference in Las Vegas for the American Association of Preferred provider Organizations, where Linda Vincent, RN.PI. of the Identity Advocate will be presenting a workshop on Medical Identity Theft. Check the registration form for other topics and speakers as well as added value information: http://www.fchn.com/documents/RegistrationFormB%20non-members.pdf
Medical Identity Theft from a Victims Perspective
See Fox News clip on You Tube: http://www.youtube.com/watch?v=Pz__DUISB6E&feature=player_embedded
WellPoint Data Breech possibly exposes 470,000 enrollees’ to Identity Theft
It is happening again, a large corporation has the potential loss of data due to a security breech. this means medical records, social security numbers even credit card information may have been exposed. The threat of Medical Identity Theft is even greater in a a case like this. Read California Health Line article at: http://www.californiahealthline.org/articles/2010/6/30/wellpoint-breach-could-have-exposed-enrollees-medical-financial-data.aspx
Medical Identity Theft, or how the system can take your children away from you.
Watch YouTube and see how devastating Medical IdentityTheft can be to you, your records and your family:
