Medical Identity Theft: Under-Reported, Under-Researched, More Common than Generally Known

Occasionally the crime is more innocuous, Ms. Dixon continued. A poor person without health insurance needs medical care and believes the only way to get it is to steal it. Or someone who lifts a wallet at a mall and finds a health insurance card among the other treasures.

How Victims Are Harmed

Victims of medical identity theft learn about the crime in various ways: through a collection notice for bills they did not incur, an erroneous entry on a credit report, denial of insurance or notification that a payout cap has been reached, or irregularities in health insurance explanation of benefits (which most people don’t bother to read or can’t understand).

In addition, they may be denied employment because someone else’s illness is on their record, or receive the wrong medical treatment because of erroneous information in their own file-a situation that is particularly dangerous in the emergency department.

Imagine a bleeding patient given a transfusion of the wrong type blood. Or someone with a hot gallbladder told he had it removed two years ago. Or a cancer patient’s file that has someone else’s PET scan. Or erased data about a previous anaphylactic reaction to penicillin.

And what if the thief has died, but the victim is still alive and needs medical care? Think about walking into a doctor’s office (or worse, the ER) and being informed that you’re dead.

Use of stolen medical information is rarely a one-shot deal. The FTC says that it is often misused for a substantial period of time. Thirteen percent of victims report misuse for six months or more.

Victims Almost Powerless

Victims of medical identity theft cannot escape the consequences because they have no enforceable rights, Ms. Dixon noted. Patients can see their medical records (usually after asking more than once and having to pay for a photocopy), but they cannot correct errors, and the theft may not even be evident in the record.

Moreover, they are powerless to prevent providers, clearinghouses, and insurers from perpetuating the fraudulent information.

Ms. Dixon said that victims do not have the legal right to demand correction of medical information that was not created by the provider or insurer currently using it-even when false entries were put in the record during the commission of a crime.

Health care providers are not required to amend records they didn’t create, and they are reluctant to do so voluntarily for fear of liability. So victims of medical identity theft can spend years running from doctor to doctor, to insurance company, to laboratory, to pharmacy trying to get things straightened out. In the end, mistakes keep slipping by.